Abstract
While pleural effusion as a complication of pancreatitis has been described in adults, this entity has not been noted, in the English literature, in children. We have recently uncovered chronic pancreatitis as the cause of recurrent pleural effusions in an 8-year-old Puerto Rican male whose presenting complaint at another hospital was recurrent substernal and epigastic pain radiating to the left shoulder. Exhaustive investigation, including cultures of the pleural fluid, skin tests for typical and atypical mycobacteria and fungi, lupus preparations, bronchography and thoracotomy with pleural biopsy, failed to reveal the cause of the recurrent pleural effusions. Substernal pain recurred, and the initial complaint of epigastric pain was only then appreciated. Pleural fluid showed an amylase concentration of more than 1000 Somogyi units/100 ml at a time when the serum amylase content was 335 units/100 ml (normal = 30–180 units). Pancreatic stimulation with secretin (Boots) 1 unit/kg resulted in a 1 hour output of 25 ml or 1.4 ml/kg (normal = 2 ml/kg), and a maximal amylase concentration of 29 mEq/L (normal = 90 mEq/L), consistent with chronic pancreatitis. There was no family history of pancreatitis. Lipoprotein electrophoresis and urinary amino acid excretion were normal. Tests for mumps complement-fixing antibodies were negative. Pancreatitis should be considered as a possible cause of pleural effusion in childhood. Pleural-fluid amylase levels should be obtained in all children with unexplained pleural effusions.
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Kopel, F., Gribetz, I., Grotsky, H. et al. Recurrent pleural effusion: A complication of pancreatitis in childhood. Pediatr Res 5, 389–390 (1971). https://doi.org/10.1203/00006450-197108000-00078
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DOI: https://doi.org/10.1203/00006450-197108000-00078