Of ten patients with pancreaticopleural fistulas, who ranged in age from 28 to 62 years, eight had primarily thoracic symptoms and no abdominal symptoms. The other two had abdominal pain after acute pancreatic injury. Computed tomographic scans disclosed pseudocysts in nine patients. The effusions resolved in four of the ten patients with transthoracic drainage, although two of these patients later required surgery because of recurrent pseudocysts. One patient died 17 days after repair of an abdominal aortic aneurysm; this patient had been treated by tube thoracostomy. Five patients underwent surgery; in four of them pancreatography was used to delineate the site of disruption preoperatively. These patients all survived, and none required subsequent surgical treatment.