Optimizing management of pancreaticopleural fistulas

Figure 1 Computed tomography scan demonstrates left pleural effusion and a fluid collection extending through the esophageal hiatus that corresponds to a pancreaticopleural fistula (arrow).

Figure 2 Endoscopic retrograde cholangiopancreatography shows a ductal leakage (arrow) in the tail of the pancreas with the contrast spreading into the chest.

Figure 3 Magnetic resonance cholangiopancreatography demostrates a pancreaticopleural fistula (arrow) extending from a ductal disruption (arrowhead) at the tail of the pancreas into the chest. A ductal blockage in the body of the pancreas precluded evaluation of the anatomy of the upstream duct in endoscopic retrograde cholangiopancreatography.

Figure 4 The algorithm for the treatment of pancreaticopleural fistulas. ¹Complete ductal blockage due to stones may be approached with endoscopic or extracorporeal lithotripsy. ²Successful endotherapy: The stent inserted across the site of a ductal disruption or traverses a ductal stricture. MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography.