Pancreatic pleural effusion due to an internal fistula is an uncommon and often unrecognized clinical syndrome which complicates chronic pancreatitis. It frequently presents with chest and respiratory symptoms of pleural effusion with little abdominal complaints, and history of previous pancreatic disease is often absent, making the diagnosis easily missed. A case of pancreatic pleural effusion due to an internal fistula is presented. To the best of our knowledge, this is the only case report in English journals on a pancreatico-pleural fistula resulting in pleural effusion that was not massive and the effusion amylase level was below 1,000 IU/L while being diagnosed. The potential of computed tomography in the diagnosis of this disease is illustrated.