The etiologies of pleural effusion range from cardiopulmonary diseases to symptomatic inflammatory or malignant diseases; in addition, ascites or lesser sac fluid collection in chronic pancreatic disease may also be associated with pleural effusion. While tube thoracostomy drainage can be used to identify and diagnose hemothorax, pancreatic disease is generally not considered in patients solely presenting with massive hemothorax [
2]. Thus, it is important that any history of pancreatitis is noted, as one of the complications of non-traumatic pancreatitis is pancreatic pseudocysts. In general, pancreatic pseudocysts develop approximately 3 to 4 weeks after acute pancreatitis, and are most often manifested by an epigastric mass or sensation of fullness. Moreover, bleeding, fistula formation, infection, and extension are known complications of pseudocysts [
3].
Decisions on the treatment of pancreatic pseudocysts are currently based on the clinical setting, the presence or absence of symptoms, the stage and size of the pseudocyst, and the presence or absence of complications [
4]. The currently available treatment options include observation, percutaneous catheter drainage, endoscopic drainage, and surgical intervention [
5]. Observation is generally only performed for asymptomatic pseudocysts that remain stable or diminish in size [
6]; however, attention should be paid to the occurrence of complications such as infection, fistula, intractable pain, or rupture [
7,
8]. Percutaneous catheter drainage is generally indicated for pseudocysts only after a 6-week delay to allow the pseudocyst wall to thicken and mature [
9]. Its contraindications include suspicion of malignancy, collections associated with a solid or non-drainable pancreatic mass, lack of a safe access route, recent or active hemorrhage into the collection (the presence of an arterial pseudoaneurysm), and collections associated with obstruction of the main pancreatic duct [
10,
11]. Furthermore, endoscopic drainage of pancreatic pseudocysts appears to be a safe, effective, and definitive treatment for patients in whom anatomic considerations allow its use [
12]. One such endoscopic method, endoscopic retrograde cholangiopancreatography, can be used to open the sphincters of the pancreatic valve ducts, thereby resulting in decompression of the pancreatic fluid collection, and can, moreover, aid in the stent placement in cases of pancreatic ductal disruption [
4]. The drawbacks of endoscopic methods include the need for extensive training and experience of the gastroenterologist, the need for a surgical backup plan, as well as the fact that the presence of an abnormal pancreatic duct system makes this procedure difficult to perform. However, surgery remains the standard method for drainage of pancreatic pseudocysts, against which new methods are being compared. The surgical treatment options consist of gastrocystostomy, duodenocystostomy, Roux-en-Y cystojejunostomy, and distal pancreatectomy (left-sided resection), depending on the leakage lesion. However, these operative procedures reportedly carry a 10 to 30 % morbidity rate, a 1 to 5 % mortality rate, and a 10 to 20 % recurrence rate [
13]. Gastrocystostomy and jejunocystostomy are alternative procedures for establishing internal decompression [
14], and duodenocystostomy is occasionally indicated for small cysts in the pancreatic head [
15], whereas distal pancreatectomy is indicated for pancreatic lesions extending to the left of the midline and that do not include the duodenum and distal bile duct.