Pancreaticopleural Fistula Visualized by Multidetector Row Computed Tomography

A 75-year-old man visited our hospital complaining of dyspnea on working and abdominal fullness. He had consumed heavy alcohol daily for the past 40 years. Chest radiography showed bilateral pleural effusion, and the pleural fluid amylase level was increased markedly to 6776 IU/L. Multidetector row computed tomography showed extensively distributed pancreatic stones in the dilated main pancreatic duct and massive ascites (Figure A). Its coronal (Figures B–D, arrow delineating the fistulous tract) and sagittal (Figure E, arrow delineating the fistulous tract) cine images showed a fistula that arose from the dilated main pancreatic duct and extended cranially along the esophagus into the mediastinum. After 3 weeks of hyperalimentation with administration of octreotide, the pleural effusion and ascites disappeared with closure of the fistula.

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A pancreaticopleural fistula can be shown by endoscopic retrograde cholangiopancreatography1 or magnetic resonance cholangiopancreatography,2 but these imaging methods sometimes fail to show an entire fistulous tract. Today, multidetector row computed tomography allows the acquisition of entire and large volumes, which can be managed easily and quickly with 3-dimensional imaging. Multidetector row computed tomography is a noninvasive, useful imaging method that can show pancreaticopleural fistulas.