A Rare Case Report on Massive Pleural Effusion due to Chronic Necrotizing Pancreatitis and its Management.

Hemorrhagic pleural effusion as the sole manifestation of pancreatitis is exceedingly rare and often presents diagnostic challenges due to its misleading symptoms. We report the case of an adult male with a large left-sided black pleural effusion secondary to chronic necrotizing pancreatitis. The patient presented with progressive shortness of breath and cough, with a history of alcohol use and a previous diagnosis of acute severe pancreatitis. Initial assessment revealed significant respiratory distress and imaging confirmed massive pleural effusion. Pleural fluid analysis and subsequent imaging identified chronic necrotizing pancreatitis as the cause. Immediate management with thoracentesis, pleural drainage, and conservative treatment with fluids and antibiotics led to significant clinical improvement. This case highlights the importance of thorough clinical evaluation and timely intervention in managing rare presentations of pancreatic diseases. Effective treatment with chest tube drainage and conservative pancreatitis management can yield positive outcomes even in severe cases. Despite the rarity of pleural effusion due to chronic pancreatitis, clinicians should maintain a high index of suspicion, particularly in patients with a relevant history, to ensure prompt and appropriate management.