Pancreatitis with or without pseudocyst formation or pancreatic pleural fistula is the most common cause of amylase elevation in pleural fluid. Rupture of the esophagus is the second most common group and malignant effusion is the third. Other causes include pancreatic ascites and pancreatic duct trauma. Defect in the wall of the gastrointestinal tract (eg, perforated peptic ulcer) will allow pancreatic secretion to enter the peritoneal cavity. Similarly, peritoneal fluid amylase elevations may be found in the presence of necrotic bowel. Peritoneal fluid, containing such amylase, can find its way into a pleural space.

Sterile container

Transfer aspirated fluid to a Transfer vial/tube with cap - 12mL (LabCorp) as soon as possible after collection.

Transfer vial/tube with cap - 12mL (LabCorp)

• Source of fluid (eg, synovial, cyst)

Ambient (preferred) - 14 days

Refrigerated - 14 days

Frozen - 14 days

Freeze/thaw cycles - stable x 3

Enzymatic

Lymph:    50 - 83

Synovial: not established

Most patients with pancreatic ascites have high peritoneal fluid amylase as well as amylase elevations in serum and urine. Pancreatitis may present with pleural effusion. Of 34 patients who had high amylase in pleural fluid associated with neoplasms, 18 had carcinoma of lung. Other tumors were gynecologic, gastrointestinal, lymphoma, breast and malignancy of unknown origin.