Thoracic manifestations of internal pancreatic fistulas: report of five cases.

Thoracic manifestations of internal pancreatic fistulas are rare. During the last 8 yr, we have treated one patient with a mediastinal pseudocyst, three patients with pancreaticopleural fistulas, and one patient with a pancreaticobronchial fistula. Recurrent pleural effusions represent one of the main clinical features in this entity, and can often lead to false diagnoses. Determination of pancreatic enzyme activity, as well as the combination of ultrasonography, computerized tomography, and endoscopic retrograde cholangiopancreatography (ERCP), enable the establishment of the diagnosis. A complete pancreatic evaluation is the rationale for an adequate and efficient therapy which should always aim at a focal assentation.