This is how it happened.... Part 3

Then came May 6, 2025.

I went to my primary care physician (PCP) for a follow-up related to the ulcer event. While I was there, I mentioned that I felt upper respiratory congestion and had been coughing up junk.

I assumed it was just my normal seasonal sinus infection that shows up around that time of year. The doctor ordered a chest X-ray.

The X-ray showed fluid in my pleural space around my left lung — enough that he said I needed a thoracentesis. That sounded fun.

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Two weeks later (and more needles)

It took two weeks to get an appointment for the thoracentesis, which finally happened on May 20. Yes, it involved needles. They drained 2.5 liters of fluid.

While we were at it, they also ordered a CT scan.

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Words you never want to read

The CT scan report stated:

“There is abnormal soft tissue density in the upper retroperitoneum adjacent to the celiac artery and anterior to the adrenal gland. There is some soft tissue thickening along the diaphragmatic crus at the site. This is concerning for neoplasm.”

Let me back up for a moment, because this part matters later.

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Bad timing...

During the first week of May, I was told that I was being laid off — along with everyone on my team. We had been building a cool software test automation product, but due to financial reasons, the company was trying to sell, and the buyers didn’t want any software development assets.

We were told we’d be paid through the end of May, with May 30 as our official last day. Along with job loss comes benefits loss. We’ll talk about COBRA later — it’s expensive, but in my case, it ended up saving me a lot of money.

I started looking for work immediately, but had no luck throughout May.

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The call that changed everything

On May 29 — the day before my job officially ended — my PCP called and asked me to come in to discuss lab results.

The fluid they drained showed very high levels of amylase, a pancreatic digestive enzyme. In short: my body was eating itself.

This indicated that my pancreas was leaking fluid into the pleural space. My PCP consulted with a surgeon, and they decided I needed to go to the emergency room to be admitted.

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What was actually happening (AI-assisted explanation)

The following explanation was generated with the help of ChatGPT, because this condition is rare and complicated.

A pancreatico-pleural fistula (PPF) is a rare but serious complication of pancreatitis, particularly chronic pancreatitis. It involves an abnormal connection between the pancreatic ductal system and the pleural cavity (the space surrounding the lungs).

“Pancreatico-pleural fistula connecting from the distal pancreas to the pleura at the level of the diaphragmatic crus.”

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Breaking that down

• Distal pancreas: The tail end of the pancreas, near the spleen.
• Fistula: An abnormal passage allowing pancreatic enzymes to leak from the pancreatic duct.
• Pleura: The membrane around the lungs, where enzyme leakage causes massive pleural effusions.
• Diaphragmatic crus: Tendinous structures attaching the diaphragm to the vertebral column.

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Clinical significance

• Symptoms: Shortness of breath, chest pain, and recurrent pleural effusions.
• Diagnosis: CT scan or MRCP, plus pleural fluid analysis showing high amylase.
• Treatment: Conservative (NPO, medications like octreotide), endoscopic (ERCP with stenting), or surgical if refractory.

Summary: A leak from the tail of the pancreas created an abnormal channel through the diaphragm into the pleural space, causing repeated fluid buildup around the lungs.

(This post was not written by AI except where explicitly noted.)