Black pleural effusion: an unusual complication of pseudocyst pancreas


  • Spandana Jagannath Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
  • Ashok Kumar Department of General Surgery, Lady Hardinge Medical College, New Delhi, India



Black pleural effusion, Pancreaticopleural fistula, Pseudocyst pancreas


Pleural effusion following rupture of pancreatic pseudocyst into the pleural cavity resulting into pancreaticopleural fistula is an extremely uncommon complication of acute pancreatitis. Pancreaticopleural fistula also results from disruption of a major pancreatic duct usually due to an underlying pancreatic disease (chronic pancreatitis), trauma, or iatrogenic injury. Pleural effusion is predominantly left sided; however, right-sided and bilateral effusion occurs in 19% and 14% of patients respectively. The pleural effusate can be either serous, serosanguinous or black in colour. Analysis of pleural fluid for raised amylase will confirm the diagnosis and investigations like computed tomography (CT), endoscopic retrograde cholangiopancreatography (ECRP) or magnetic resonance cholangiopancreatography (MRCP) may establish the fistulous communication between the pancreas, pseudocyst and pleural cavity. The optimal treatment strategy has traditionally been medical management with thoracocentesis and/or tube thoracostomy and exocrine suppression with octreotide and ERCP stenting of the fistulous pancreatic duct. Surgery, in the current era, is considered in the event patient fails to respond to conservative management or the patient’s condition deteriorates. We report the case of a 24-years-old gentleman who was diagnosed with chronic idiopathic pancreatitis with pseudocyst who developed right sided black pleural effusion.


Burgess NA, Moore HE, Williams JO, Lewis MH. A review of pancreatico-pleural fistula in pancreatitis and its management. HPB Surg. 1992;5(2):79-86.

Uchiyama T, Suzuki T, Adachi A, Hiraki S, Iizuka N. Pancreatic Pleural Effusion: Case Report and Review of 113 Cases in Japan. Am J Gastroenterol. 1992;87(3):387-91.

Cazzo E, Apodaca RM, Gestic MA, Chaim F, Saito H, Utrini MP, et al. Management of pancreaticopleural fistulas secondary to chronic pancreatitis. Arq Bras Cir Dig. 2017;30(3):225-8.

Sut M, Gray R, Ramachandran M, Diamond T. Pancreaticopleural fistula: a rare complication of ERCP-induced pancreatitis. Ulster Med J. 2009;78(3):185-6.

Ali T, Srinivasan N, Le V, Chimpiri AR, Tierney WM. Pancreaticopleural fistula. Pancreas. 2009;38(1):26-31.

Villena V, Encuentra A, Garcia LR, Echave SJ, Martínez CJ. Clinical implications of appearance of pleural fluid at thoracentesis. Chest. 2004;125(1):156-9.

Rockey DC, Cello JP. Pancreaticopleural fistula. Report of 7 patients and review of the literature. Medicine. 1990;69:332-44.






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