The first adult case of a congenital communication between the biliary tract and the right main bronchus is reported. Treatment by surgical excision and pneumonectomy was successful.Since 1952, when the first case of a congenital fistula between the respiratory and biliary tract was reported by Neuhauser et al,' only 14 cases of this malformation have been described.2" All have been in infants or children and the abnormality has led to respiratory distress, with a fatal outcome in some children. Three patients had other biliary malformations.24' The following case is the first to be described in an adult. Case reportA 32 year old white woman was admitted to hospital in January 1985 because of fever and severe productive cough with greenish yellow sputum. She gave a history of continuous expectoration of golden yellow sputum, which increased greatly after meals. She had had frequent episodes of bronchopulmonary infections since she was two months old and had required two or more courses ofantibiotics a year for acute chest infections. On examination she was thin and had the appearance of being chronically unwell. Her temperature was 38°C and she was expectorating large quantities of yellow mucus.On examination there was chest wall retraction, rhonchi, and crepitations in the right hemithorax. The chest radiograph showed opacification ofthe right lung and a shift ofthe mediastinum to this side. The sputum pH was 8-0 and the bilirubin concentration was 2-2 mg/100 ml (37-6 ymol/l).
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