A new diagnostic approach for bilious pleural effusion

Saraya, Takeshi; Light, Richard W.; Sakuma, S; Nakamoto, Yoshiaki; Wada, Shoko; Ishida, Mitsuo; Inui, Toshiya; Koide, Takao; Ishii, Haruyuki; Takizawa, Hajime

doi:10.1016/j.resinv.2016.03.009

Cited by 9 publications

(18 citation statements)

References 18 publications

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“…The optimal treatment of biliothorax is operative, closing the biliopleural fistula with a high rate of success 1 . In the last years, there is a trend towards a conservative management with chest tube drainage and biliary stenting to reduce ductal pressure and promote spontaneous BPF closure 2,3 …”

Section: Discussionmentioning

confidence: 99%

“…Most of them are associated with malignant or benign biliary obstruction, pleurobiliary fistulas after hepatobiliary procedures (surgery or percutaneous drainage) and hepatic or subphrenic abscesses. [1][2][3]5 The right pleural cavity is usually involved due to anatomical proximity, but bile can also drain naturally through the oesophageal and aortic hiatuses, which can involve the left pleural cavity. 5 The most specific diagnostic criteria is the ratio of total pleural fluid bilirubin to total serum bilirubin, which, when it is greater than 1, confirms the diagnosis of biliothorax.…”

Section: Discussionmentioning

confidence: 99%

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Biliothorax in a patient with unresectable cholangiocarcinoma

Valero,

Copoví,

Boira

et al. 2023

Respirology Case Reports

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Biliothorax is a rare but serious condition, as the presence of bile is damaging and can lead to empyema. Here, we report a case of a 51‐year‐old man recently diagnosed with unresectable cholangiocarcinoma, admitted to the hospital for malignant obstructive jaundice. After interventional management of biliary obstruction, the patient developed a significant right pleural effusion compatible with biliothorax, successfully managed with pleural drainage and antibiotic therapy. Resolution was possible with a conservative approach: biliary decompression, chest tube drainage and antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Biliothorax in a patient with unresectable cholangiocarcinoma

Valero,

Copoví,

Boira

et al. 2023

Respirology Case Reports

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“…2 A pleural to serum total bilirubin ratio of > 1 and the presence of pleural glycoholic acid support the diagnosis of a cholethorax. 9 Once a cholethorax has been identified, it is important to diagnose the source of the biliary leak to guide further management. Noninvasive imaging modalities to consider include: (1) abdominal ultrasound as a quick screen for intra-abdominal ascites, perihepatic discrete fluid collections, and fluid collections in the gallbladder surgical bed; (2) CT scan to assess for presence and age of biloma based on peripheral rim thickness and for peritoneal thickness and enhancement which may be suggestive of biliary peritonitis;…”

Section: Discussionmentioning

confidence: 99%

Delayed Presentation of Cholethorax Following Hepatic Microwave Ablation and Resection in a Patient With Metastatic Rectal Cancer

Wong

Dincer

Keenan

et al. 2019

Journal of Bronchology &Amp; Interventional Pulmonology

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FIGURE 2. Right pleural effusion and thoracentesis. Demonstration of large right-sided pleural effusion (A) and appearance of the pleural fluid postthoracentesis (B).FIGURE 1. A-C, Magnetic resonance imaging of the abdomen showing multiple T2 hyperintense liver lesions, improvement in size of liver lesions after treatment with FOLFOX 2 months later, recurrence of liver lesions 1 year after initial magnetic resonance imaging.

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“…In 50% of cases, empyema occurs as a complication ( table 2 ). A recent review of 12 cases revealed that a PF total bilirubin to serum total bilirubin ratio >1 combined with the presence of pleural glycocholic acid has a high diagnostic yield [ 97 ]. Once stabilised, a magnetic resonance (MR) cholangiopancreatography is necessary to find the cause and site of biliary obstruction.…”

Section: Gallbladder Diseasesmentioning

confidence: 99%

Pleural effusion due to nonmalignant gastrointestinal disease

et al. 2022

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Although pleural effusion is a frequent finding in clinical practice, determining its etiology may be challenging, and up to 20% of cases remain undiagnosed. Pleural effusion may occur secondary to a non-malignant gastrointestinal disease. A gastrointestinal origin is confirmed based on a review of the medical history of the patient, and thorough physical examination and abdominal ultrasonography. In this process, it is crucial to correctly interpret findings on pleural fluid obtained by thoracentesis. In the absence of high clinical suspicion, identifying the etiology of this type of effusion may be difficult. Clinical symptoms will be determined by the gastrointestinal process causing PE. In this setting, correct diagnosis relies on the specialist's ability to associate pleural fluid appearance, test for the appropriate biochemical parameters, and determine whether it is necessary or not to send a specimen for culture. The established diagnosis will determine how pleural effusion is approached. Although this clinical condition is self-limited, many cases will require a multidisciplinary approach, as some effusions only resolved with specific therapies.

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A new diagnostic approach for bilious pleural effusion

Cited by 9 publications

References 18 publications

Biliothorax in a patient with unresectable cholangiocarcinoma

Biliothorax in a patient with unresectable cholangiocarcinoma

Delayed Presentation of Cholethorax Following Hepatic Microwave Ablation and Resection in a Patient With Metastatic Rectal Cancer

Pleural effusion due to nonmalignant gastrointestinal disease

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