BACKGROUND Pancreaticopleural fistula is rare. It occurs as a complication in acute and chronic pancreatitis. Here we report a case of persistent unilateral pleural effusion secondary to pancreaticopleural fistula. METHODS A 37 year old non alcoholic gentleman who had no history of pancreatitis and presented with breathlessness and tachypenia. X-ray chest showed massive pleural effusion on the right side. Amylase estimation of the tapping fluid was very high. ERCP showed a pancreaticopleural fistula. CONCLUSIONS Pancreaticopleural fistula is a rare entity with an incidence of 0.4-4.5%. It occurs either as a complication in pancreatitis, or after injury of the pancreatic duct. A greatly elevated pleural fluid amylase is usually the first step towards the diagnosis. ERCP and CT will identify the fistulous tract in 70%. Treatment is mainly directed towards intercostal drainage and control of the fistula. CONCLUSIONS Presentation is misleading in most of cases and needs aware clinicians with a high index of suspicion.