Cheng Yi Wang, Shu Fang Huang, Jui Fu Chung, Fu Hsuan Kuo, Wen Yi Chiu and Wu Hsien Kuo
A 54-year-old male presented with massive left bloody pleural effusion. Thoracocentasis revealed high level of amylase and lipase. The abdomen computed tomogram (CT) scan showed a pseudocyst of pancreatic tail and necrotizing pancreatitis with walled off necrosis formation that encroaching splenic vein and esophagus with upward extension to middle mediastinum and bilateral pleural effusion. The other differential diagnosis such as oesophageal perforation and certain neoplastic processes should be considered. After surgery of distal pancreatectomy with splenectomy, the symptom relieved.
