{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T20:56:20Z","timestamp":1789419380685,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Pancreaticopleural fistula is a rare complication of chronic pancreatitis resulting from pancreatic duct disruption, typically presenting with pleural effusion and predominant respiratory symptoms. Bilateral pleural involvement is exceptionally uncommon and poses significant diagnostic and therapeutic challenges. Case Presentation: A 56-year-old man with a history of chronic alcohol abuse presented with progressive dyspnea and mild epigastric pain. Imaging revealed bilateral pleural effusions, an atrophic pancreas with a markedly dilated main pancreatic duct containing calculi, and a fistulous tract extending from the pancreatic body through the esophageal hiatus into the mediastinum. Magnetic resonance cholangiopancreatography confirmed the diagnosis of chronic calculous pancreatitis complicated by a pancreaticopleural fistula. After unsuccessful conservative management, the patient underwent distal pancreatectomy, resection of the fistulous tract, and Roux-en-Y pancreatojejunostomy. The postoperative course was uneventful, with complete resolution of pleural effusions and sustained clinical improvement. Conclusions: This case highlights the importance of considering pancreaticopleural fistula in patients with unexplained pleural effusions and minimal abdominal symptoms, particularly in the context of chronic pancreatitis. Bilateral involvement, although rare, should not preclude timely diagnosis. Appropriate diagnostic studies by computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography are crucial for establishing the diagnosis. Surgical management offers definitive treatment in patients with ductal obstruction and calculous disease, resulting in excellent long- term outcomes.<\/jats:p>","DOI":"10.3390\/diagnostics16050720","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:22:21Z","timestamp":1772551341000},"page":"720","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Bilateral Pancreaticopleural Fistula Masquerading as Thoracic Disease in Chronic Calculous Pancreatitis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2763-9557","authenticated-orcid":false,"given":"Helen","family":"Bolanaki","sequence":"first","affiliation":[{"name":"Second Department of Surgery, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7198-2628","authenticated-orcid":false,"given":"Francesk","family":"Mulita","sequence":"additional","affiliation":[{"name":"Second Department of Surgery, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"},{"name":"Department of Surgery, Medical School, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8855-6358","authenticated-orcid":false,"given":"Ioannis","family":"Tzimagiorgis","sequence":"additional","affiliation":[{"name":"Second Department of Surgery, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Chrysafis","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hippocrates","family":"Moschouris","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Courcoutsakis","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5459-6845","authenticated-orcid":false,"given":"Savas P.","family":"Deftereos","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9278-4273","authenticated-orcid":false,"given":"Anastasios J.","family":"Karayiannakis","sequence":"additional","affiliation":[{"name":"Second Department of Surgery, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1001\/archsurg.1969.01340070080014","article-title":"Massive bilateral hemorrhagic pleural effusions in chronic relapsing pancreatitis","volume":"98","author":"Miridjanian","year":"1969","journal-title":"Arch. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1136\/bmj.1.5849.330","article-title":"Pleural effusion with pancreaticopleural fistula","volume":"1","author":"Tombroff","year":"1973","journal-title":"Br. Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1097\/MPA.0b013e3181870ad5","article-title":"Pancreaticopleural fistula","volume":"38","author":"Ali","year":"2009","journal-title":"Pancreas"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1097\/00000658-197611000-00009","article-title":"Internal pancreatic fistulas: Pancreatic ascites and pleural effusions","volume":"184","author":"Cameron","year":"1976","journal-title":"Ann. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1097\/00005792-199011000-00002","article-title":"Pancreaticopleural fistula. Report of 7 patients and review of the literature","volume":"69","author":"Rockey","year":"1990","journal-title":"Medicine"},{"key":"ref_6","first-page":"90","article-title":"Pancreaticopleural fistula: A review","volume":"16","author":"Aswani","year":"2015","journal-title":"J. Pancreas"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"815476","DOI":"10.1155\/2012\/815476","article-title":"Pancreaticopleural fistula: Revisited","volume":"2012","author":"Machado","year":"2012","journal-title":"Diagn. Ther. Endosc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2655","DOI":"10.2169\/internalmedicine.51.7859","article-title":"Bilateral pleural fluid caused by a pancreaticopleural fistula requiring surgical treatment","volume":"51","author":"Sonoda","year":"2012","journal-title":"Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"190","DOI":"10.11622\/smedj.2013071","article-title":"Diagnosis and management of pancreaticopleural fistula","volume":"54","author":"Tay","year":"2013","journal-title":"Singap. Med. J."},{"key":"ref_10","first-page":"748","article-title":"Surgical treatment of pancreatic ascites and pancreatic pleural effusions","volume":"42","author":"Machado","year":"1995","journal-title":"Hepatogastroenterology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S174","DOI":"10.1016\/j.mjafi.2024.10.010","article-title":"Pancreatico-Pleural Fistula: Revisiting a rare complication","volume":"81","author":"Adiody","year":"2025","journal-title":"Med. J. Armed Forces India."},{"key":"ref_12","first-page":"230","article-title":"Pancreaticopleural fistula visualized by computed tomography scan combined with pancreatography","volume":"7","author":"Fujiwara","year":"2006","journal-title":"JOP"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5572","DOI":"10.1097\/JS9.0000000000002610","article-title":"Management of pancreaticopleural fistulas secondary to pancreatitis: A systematic review","volume":"111","author":"Kayyal","year":"2025","journal-title":"Int. J. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1186\/s13256-024-04457-8","article-title":"Pancreaticopleural fistula causing pleural effusion: A case report and review of the literature","volume":"18","author":"Khadka","year":"2024","journal-title":"J. Med. Case Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/00004728-199903000-00004","article-title":"Thoracopancreatic fistula: Clinical and imaging findings","volume":"23","author":"Fulcher","year":"1999","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e14233","DOI":"10.1097\/MD.0000000000014233","article-title":"Pancreaticopleural and Pancreaticomediastinal Fistula Extending to the Cervical Region, with Dysphagia as Initial Symptom: A Case Report","volume":"98","year":"2019","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e41184","DOI":"10.1097\/MD.0000000000041184","article-title":"Comprehensive treatment strategy for pancreaticopleural fistula: A rare case report and review of 91 cases","volume":"104","author":"Zhao","year":"2025","journal-title":"Medicine"},{"key":"ref_18","first-page":"102163","article-title":"Pancreatopleural fistula: A rare cause of recurrent pleural effusion","volume":"53","author":"Dhanani","year":"2025","journal-title":"Respir. Med. Case Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/0149-936X(86)90070-6","article-title":"Pancreaticopleural fistula: Demonstration by computed tomography and endoscopic retrograde cholangiopancreatography","volume":"10","author":"Bronner","year":"1986","journal-title":"J. Comput. Tomogr."},{"key":"ref_20","first-page":"671","article-title":"Pancreaticopleural fistula: An unusual complication of pancreatitis diagnosed with magnetic resonance cholangiopancreatography","volume":"10","author":"Vyas","year":"2009","journal-title":"JOP"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1186\/s13256-024-04761-3","article-title":"Minimally invasive treatment of an internal pancreaticopleural fistula with massive pleural effusion: A case report","volume":"18","author":"Raab","year":"2024","journal-title":"J. Med. Case Rep."},{"key":"ref_22","first-page":"89","article-title":"Association between perineural infiltrations and delayed gastric emptying after Whipple procedure for periampullary tumours, and the relationship with other clinicopathological factors and overall survival","volume":"19","author":"Bouchagier","year":"2024","journal-title":"Prz Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1378\/chest.117.3.912","article-title":"Pancreaticopleural fistula: Diagnosis with magnetic resonance pancreatography","volume":"117","author":"Materne","year":"2000","journal-title":"Chest"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s00261-001-0144-2","article-title":"Pancreatic pleural effusion with a pancreaticopleural fistula diagnosed by magnetic resonance cholangiopancreatography and cured by somatostatin analogue treatment","volume":"28","author":"Akahane","year":"2003","journal-title":"Abdom. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1177\/0218492312474453","article-title":"Pancreaticopleural fistula: An overlooked entity","volume":"22","author":"Altasan","year":"2014","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/j.surg.2006.02.020","article-title":"Evaluation and management of thoracopancreatic fistula","volume":"140","author":"Tajima","year":"2006","journal-title":"Surgery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10620-006-3073-7","article-title":"Pancreaticopleural fistula: Report of two cases and review of the literature","volume":"51","author":"Oh","year":"2006","journal-title":"Dig. Dis. Sci."},{"key":"ref_28","first-page":"152","article-title":"Nonsurgical management of pancreaticopleural fistula","volume":"6","author":"Dhebri","year":"2005","journal-title":"JOP"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1185\/030079900750120269","article-title":"Marked effect of octreotide acetate in a case of pancreatic pleural effusion","volume":"16","author":"Takeo","year":"2000","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4696","DOI":"10.3748\/wjg.v17.i42.4696","article-title":"Optimizing management of pancreaticopleural fistulas","volume":"17","author":"Wronski","year":"2011","journal-title":"World J. Gastroenterol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1055\/s-2006-925062","article-title":"Endoscopic management of pancreaticopleural fistulas: A report of three patients","volume":"38","author":"Koshitani","year":"2006","journal-title":"Endoscopy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.pan.2013.08.006","article-title":"Endoscopic transpapillary pancreatic stenting for internal pancreatic fistula with the disruption of the pancreatic ductal system","volume":"13","author":"Tanaka","year":"2013","journal-title":"Pancreatology"},{"key":"ref_33","first-page":"184","article-title":"The value of the endoscopic pancreatogram in peritoneal or pleural pancreatic fistula","volume":"81","author":"Nordback","year":"1996","journal-title":"Int. Surg."},{"key":"ref_34","first-page":"735","article-title":"Surgical management of pancreaticopleural fistulas","volume":"109","author":"Olakowski","year":"2009","journal-title":"Acta Chir. Belg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1055\/s-0033-1334996","article-title":"Pancreaticopleural fistula-induced empyema thoracis: Principles and results of surgical management","volume":"61","author":"Schweigert","year":"2013","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_36","first-page":"1678","article-title":"Surgical treatment for right pleural effusions caused by pancreaticopleural fistula","volume":"50","author":"Shibasaki","year":"2003","journal-title":"Hepatogastroenterology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/01.mcg.0000139051.74801.43","article-title":"Internal pancreatic fistulas: Proposal of a management algorithm based on a case series analysis","volume":"38","author":"Chebli","year":"2004","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000210442","article-title":"Two Patients with Chronic Pancreatitis Complicated by a Pancreaticopleural Fistula","volume":"3","author":"Kiewiet","year":"2009","journal-title":"Case Rep. Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e261933","DOI":"10.1136\/bcr-2024-261933","article-title":"Pancreaticopleural fistula: A rare aetiology of pleural effusion","volume":"17","author":"Kabay","year":"2024","journal-title":"BMJ Case Rep."},{"key":"ref_40","first-page":"9","article-title":"Pancreaticopleural fistula: You can only find it if you look for it","volume":"116","author":"Villalonga","year":"2024","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.amjms.2024.11.014","article-title":"Pancreaticopleural fistula","volume":"369","author":"Rao","year":"2025","journal-title":"Am. J. Med. Sci."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/5\/720\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:44:11Z","timestamp":1772552651000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/5\/720"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,28]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["diagnostics16050720"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16050720","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,28]]}}}