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

Reddy, Vikas D.; Al-khateeb, Anas; Hussain, Muhammad; Patel, Varun; Kadri, Muqueet; Patel, R.; Maruboyina, Siva Prasad; Miller, Richard A.; DePasquale, Joseph

doi:10.1155/2019/8658343

Cited by 4 publications

(1 citation statement)

References 6 publications

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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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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 as an endoscopic retrograde cholangiopancreatography complication and a review of the literature

Azam,

Guliyara,

Roy

2024

Respirology Case Reports

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Bilothorax, the accumulation of bile in the pleural space, is an uncommon but serious condition often linked to biliary tract or diaphragmatic injury. This case report describes a 70‐year‐old female with decompensated liver cirrhosis due to primary sclerosing cholangitis, who developed a moderate sized pleural effusion following ERCP and biliary stenting. The patient's pleural effusion persisted for 2 months without respiratory symptoms, indicating a self‐limited low‐volume leak. She eventually underwent thoracentesis for a non‐resolving unilateral effusion, which drained 435 mL of bilious fluid with an elevated pleural fluid bilirubin level, confirming the diagnosis of bilothorax. This case highlights the importance of considering bilothorax as a cause of pleural effusion in patients with biliary tract disease and who undergo high risk procedures including ERCP.

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Bilothorax: A Case Report and Systematic Literature Review of the Rare Entity

Acharya,

Kafle,

Sedhai

et al. 2024

Pulmonary Medicine

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Background. Bilothorax is defined as the presence of bile in the pleural space. It is a rare condition, and diagnosis is confirmed with a pleural fluid‐to‐serum bilirubin ratio of >1. Methods. The PubMed, Embase, Google Scholar, and CINAHL databases were searched using predetermined Boolean parameters. The systematic literature review was done per PRISMA guidelines. Retrospective studies, case series, case reports, and conference abstracts were included. The patients with reported pleural fluid analyses were pooled for fluid parameter data analysis. Results. Of 838 articles identified through the inclusion criteria and removing 105 duplicates, 732 articles were screened with abstracts, and 285 were screened for full article review. After this, 123 studies qualified for further detailed review, and of these, 115 were pooled for data analysis. The mean pleural fluid and serum bilirubin levels were 72 mg/dL and 61 mg/dL, respectively, with a mean pleural fluid‐to‐serum bilirubin ratio of 3.47. In most cases, the bilothorax was reported as a subacute or remote complication of hepatobiliary surgery or procedure, and traumatic injury to the chest or abdomen was the second most common cause. Tube thoracostomy was the main treatment modality (73.83%), followed by serial thoracentesis. Fifty‐two patients (51.30%) had associated bronchopleural fistulas. The mortality was considerable, with 18/115 (15.65%) reported death. Most of the patients with mortality had advanced hepatobiliary cancer and were noted to die of complications not related to bilothorax. Conclusion. Bilothorax should be suspected in patients presenting with pleural effusion following surgical manipulation of hepatobiliary structures or a traumatic injury to the chest. This review is registered with CRD42023438426.

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

Cited by 4 publications

References 6 publications

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

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

Bilothorax as an endoscopic retrograde cholangiopancreatography complication and a review of the literature

Bilothorax: A Case Report and Systematic Literature Review of the Rare Entity

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