Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea, non-productive cough, and pleuritic chest pain. History significant for chronic pancreatitis or recent acute pancreatic episode. Symptoms refractory to standard thoracentesis. Note presence of massive, recurrent, unilateral pleural effusion (typically left-sided).
Clinical Examination Findings
Respiratory exam reveals diminished breath sounds, dullness to percussion, and decreased tactile fremitus over the affected hemithorax. Abdominal exam may demonstrate epigastric tenderness or guarding consistent with underlying pancreatic pathology. Signs of malnutrition or weight loss may be present.
Treatment Protocol
Initial management includes bowel rest (NPO), total parenteral nutrition (TPN), and somatostatin analogues (octreotide) to reduce pancreatic secretions. Therapeutic thoracentesis for symptomatic relief. Definitive management requires ERCP with pancreatic duct stenting or surgical intervention (distal pancreatectomy or pancreaticojejunostomy) if conservative measures fail.