Background: A pancreatic-pleural fistula is a complication of a pancreatic pseudocyst due to cranial extension of an erosive tract that forms a communication between the pseudocyst and the pleural cavity with subsequent pleural effusion. Case presentation: A 16-year-old boy presented with a history of shortness of breath and cough over 3 months, with diffuse abdominal pain radiating to his back. A chest X- ray showed massive left-sided pleural effusion without any mediastinal shift. Computed tomography of the chest and abdomen showed a pancreatic-pleural fistula. This diagnosis was confirmed after thoracentesis performed for pleural fluid sampling showed an amylase level of 28,459 IU/L (reference range 30?100 IU/L). He was treated medically and an endoscopic retrograde cholangiopancreatography was performed. Conclusion: A pancreatic-pleural fistula is a rare complication of chronic pancreatitis, and endoscopic surgery is a useful treatment option in those who fail medical treatment, fluid drainage, and/or fistula stent.