Pleural Effusion as a predictor of severity in Acute Pancreatitis

Abstract

Background: Acute pancreatitis frequently involves pulmonary radiographic abnormalities. Pulmonary infiltrates, pulmonary edema associated with adult respiratory distress syndrome (ARDS), and pleural effusion are examples of significant abnormalities. Elevation of the left hemidiaphragm and basilar atelectasis are two minor findings. Exudates in the effusions are frequently hemorrhagic. When pancreatitis subsides, pleural effusions may or may not become symptomatic and disappear. Pleural effusion has been suggested as a sign of severe pancreatitis. The present study was conducted with the aim of determining whether pleural effusion is a predictor of severity in acute pancreatitis and, if so, whether it is an independent predictor. Methodology: This retrospective study was carried out at the General/Thoracic Surgery Department of Hayatabad Medical Complex Peshawar. A total of 70 cases of acute pancreatitis from January 2020 to January 2021, were included. Medical records were analyzed for evidence of pleural effusion by chest radiograph and severe acute pancreatitis by identification of pancreatic necrosis or organ system dysfunction. Data were analyzed to determine if identification of pleural effusion provided an early sign of severity. Results: Mild acute pancreatitis cases were 60 (85.7%), while 10 (14.3%) severe acute pancreatitis cases were noted. In mild acute pancreatitis, gallstone was the most common etiology 21 (35%), followed by idiopathic 15 (25%), ERCP 13 (21.7%) and alcohol 11 (18.3%) respectively.  Of 55 (78.6%) patients with mild pancreatitis who underwent chest radiography, 4 (7.2%) had pleural effusion, while 7 (70%) out of 10 patients had pleural effusion in severe acute pancreatitis (P <0.001). Conclusion: Pleural effusion is strongly associated with severity in acute pancreatitis but provides independent information on severity in only a minority of cases. Key Words: Acute pancreatitis; Pleural effusion; Severe Acute Pancreatitis