An Unusual Case of Left-Sided Massive Biliothorax

Soler-Sempere, María José

doi:10.23937/2378-3516/1410034

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…The diagnosis is based on the demonstration of bile in pleural fluid with a ratio between the pleural bilirubin and the serum greater than one, with a range of 1.4–11.6. A total pleural fluid bilirubin level of 6.8–57.78 mg/dl was reported in five of the fifty-two patients 12 , 9 .…”

Section: Discussionmentioning

confidence: 96%

“…The presence of PBF (pleural biliary fistula) secondary to choledocholithiasis, trauma, congenital malformations, or iatrogenic operations is identified as the primary etiology of biliothorax. Hepatic parasitic infestation, radiofrequency ablation of liver tumors, and biliary stent migration are further uncommon reasons that have been discussed in the literature 9 .…”

Section: Discussionmentioning

confidence: 99%

“…If untreated, the patient’s respiratory state can quickly deteriorate due to fluid-induced lung volume loss as well as an inflammatory reaction of the bile that has a direct corrosive effect on the pleural layers, which can lead to ARDS 9 , 11 .…”

Section: Discussionmentioning

confidence: 99%

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Hydatid hepatopleural fistula causing biliothorax: minimally invasive approach with ERCP stent placement and chest tube drainage: a case report

Mainali,

Sapkota,

Koirala

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction and importance: Biliothorax and hydatid bilio-bronchial fistula (HBBF) are rare complications of hydatid cysts of the liver with high perioperative mortality. Case presentation and clinical discussion: The authors here report the case of a patient with a right massive pleural effusion with evidence of HBBF in imaging studies, who underwent surgical resection of a hydatid cyst of the liver 8 years ago. The patient was managed with intercostal chest tube drainage for biliothorax and endoscopic sphincterotomy with biliary stent placement for the re-establishment of internal biliary drainage, which ultimately allowed the fistulous tract to heal without any major surgical intervention. Conclusion: This article focuses on the successful management of the HBBF at our institution. Our findings emphasize the significance of early diagnosis and the criticality of implementing aggressive and early interventions to minimize complications and fatalities. By examining this specific case and reviewing existing literature, the authors have determined that endoscopic treatment appears to be a viable, secure, and efficacious option for addressing postoperative HBBF.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Hydatid hepatopleural fistula causing biliothorax: minimally invasive approach with ERCP stent placement and chest tube drainage: a case report

Mainali,

Sapkota,

Koirala

et al. 2023

Annals of Medicine &Amp; Surgery

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“…Most cases in the literature usually present as a rightsided pleural effusion given the anatomical location of the liver and biliary tree; however, 2 cases of left-sided bilothorax and 1 case of bilateral bilothorax have also been reported. 1,[7][8][9] Observation of a pleural effusion should be followed by diagnostic thoracentesis with measurement of pleural total bilirubin. Visually, the pleural fluid will appear green-black, with an exudative profile on fluid studies.…”

Section: Discussionmentioning

confidence: 99%

Bilothorax: A Rare Complication of Percutaneous Transhepatic Biliary Drainage in a Patient With Primary Sclerosing Cholangitis

Olasehinde,

Stehouwer

2024

ACG Case Rep J

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Bilothorax is a rare etiology of pleural effusions that involves leakage of bile from the biliary system into the pleural cavity. Most cases result from iatrogenic mechanisms, like endoscopic retrograde cholangiopancreatography. However, only a limited number of cases have reported this as a complication of percutaneous transhepatic biliary drainage. We report this rare presentation in an elderly man with primary sclerosing cholangitis after receiving percutaneous transhepatic biliary drainage for decompression of multiple complex biliary obstructions. Given its rarity and lack of established guidelines, we review clinical features, medical management, and potential implications of bilothorax, especially in patients with chronic liver disease and cirrhosis.

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“…There are only a few cases of left-sided bilothorax reported in the literature. One similar case with a left-sided bilothorax was attributed to a cholangiocarcinoma causing intrahepatic dilatation and subsequent fistulous connection [6]. Other cases have involved trauma from a car accident and nasogastric tube placement complicated by the formation of a gastropleural fistula due to stomach perforation [7, 8].…”

Section: Discussionmentioning

confidence: 99%

Case Report: Kryptonite—A Rare Case of Left-Sided Bilothorax in a Sickle Cell Patient

Reddy

Al-khateeb

Hussain

et al. 2019

Case Reports in Pulmonology

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Bilothorax is a rare cause of an exudative pleural effusion. The diagnosis is confirmed by a pleural fluid to serum bilirubin ratio of greater than 1. Typically, bilothorax presents as a right-sided effusion due to its proximity to the liver and biliary system. Herein, we present a case of isolated left-sided bilothorax in a 43-year-old female admitted with sickle cell crisis. Only one other case of isolated spontaneous left-sided bilothorax has been described in the literature. A thoracentesis performed on admission demonstrated greenish fluid and bilothorax was suspected, with a pleural fluid to serum bilirubin ratio greater than 1 confirming the diagnosis. A magnetic resonance cholangiopancreatography (MRCP) showed an abnormal 90-degree acute angulation in the mid-to-distal common bile duct with proximal common bile duct and intrahepatic bile ducts dilation. This was further confirmed with an endoscopic retrograde cholangiopancreatography (ERCP), which did not reveal any extravasation of contrast into the left pleural space. Ultimately, despite the use of various modalities, no definitive cause of bilothorax was identified. Postthoracentesis imaging revealed evidence of fibrothorax, a direct and permanent complication of bilothorax. The presence of an isolated left-sided bilothorax, along with the lack of a confirmed etiology, makes this case unique.

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An Unusual Case of Left-Sided Massive Biliothorax

Cited by 5 publications

References 10 publications

Hydatid hepatopleural fistula causing biliothorax: minimally invasive approach with ERCP stent placement and chest tube drainage: a case report

Hydatid hepatopleural fistula causing biliothorax: minimally invasive approach with ERCP stent placement and chest tube drainage: a case report

Bilothorax: A Rare Complication of Percutaneous Transhepatic Biliary Drainage in a Patient With Primary Sclerosing Cholangitis

Case Report: Kryptonite—A Rare Case of Left-Sided Bilothorax in a Sickle Cell Patient

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