Pleural effusion in acute pancreatitis, not always related

A 47 year-old male patient admitted to our hospital with chief complaints of severe epigastric pain, intermittent nausea and vomiting ongoing for 2 days. The patient's heart rate was 84/minute, body temperature was 37.4°C and skin and scleras were icteric at the initial presentation. Respiratory sounds could not be hearded at the basal levels of the right lung. Laboratory tests revealed as following; hemoglobin 10.6 g/dL (13.3- 17.2), C-reactive protein 96.4 mg/L (0-5), amylase 1300 u/l (28-100), lipase 318 u/l (13-60), aspartate aminotransferase 104 u/l (< 40), alanine aminotransferase 189 u/l (< 41), lactate dehydrogenase 450 u/l (240-480), gamma-glutamil transferase 283 u/l (8-61), alkaline phosphatase 376 u/l (40-130), direct bilirubin 4.36 mg/ dl (= 0.30). Chest X-ray examination revealed pleural effusion on the right side, coming up to the level of the fifth costa. (Fig. 1a). According to the abdominal computed tomography; intrahepatic bile ducts and the common bile duct (CBD) were dilated, gall bladder was hydropic as the thickest part of it was measured as 12 mm. Diffuse enlargement of the pancreas including contour irreegularities and inhomogeneous attenuation was seen.