Cholecystopleural Fistula with Cholelithiasis Presenting as a Right Pleural Effusion

Cunningham, Laurence W.; Grobman, Marc; Paz, Harold L.; Hanlon, Catherine A.; Promisloff, Robert

doi:10.1378/chest.97.3.751

Cited by 27 publications

(16 citation statements)

References 5 publications

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“…Emphysematous bilious pleural effusions often involve organisms from the gastrointestinal tract such as Escherichia coli , Enterobacter spp. , and even Staphylococcus aureus [3]. In our case, the CT scan of the chest showed bilateral lobar consolidation coupled with pneumococcal bacteremia which was most consistent with a pulmonary etiology of infection.…”

Section: Discussionsupporting

confidence: 53%

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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Section: Discussionsupporting

confidence: 53%

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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“…35,36,38 Successful management has been reported following prompt medical and surgical therapy, 35,39 but prognosis is poor if diagnosis and treatment are delayed, as biliothorax can lead to severe manifestations of a systemic inflammatory response and death. 38,39…”

Section: Discussionmentioning

confidence: 99%

Spontaneous cholecystopleural fistula leading to biliothorax and sepsis in a cat

VanDeventer

Cuq

2019

Journal of Feline Medicine and Surgery Open Reports

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Case summaryA 13-year-old spayed female domestic shorthair cat presented with pleural effusion and suspected triaditis. Intake vitals and leukocytosis were consistent with a diagnosis of systemic inflammatory response syndrome. Biochemical analysis confirmed a pleural fluid-to-serum bile ratio consistent with a diagnosis of biliothorax. Abdominal ultrasound failed to identify a definitive gall bladder but noted a hypoechoic tubular structure ventral to the liver and contacting the diaphragm. Thoracic ultrasound identified a hyperechoic structure contacting the diaphragm at the same location. Thoracoabdominal CT scan identified a fluid-dense tubular structure extending from ventral to the liver, through a diaphragmatic defect and directly communicating with the pleural space, suspected to be an abnormal gall bladder. The cat was humanely euthanized, and post-mortem analysis confirmed a cholecystopleural fistula arising from the gall bladder with multifocal abscesses, mixed inflammatory hepatic infiltrates and small-cell gastrointestinal lymphoma. Culture of the abscess isolated Parabacteroides merdae, meeting the reported feline criteria for sepsis.Relevance and novel informationTo our knowledge, spontaneous cholecystopleural fistula formation leading to biliothorax and sepsis has not been previously reported in the cat. This case highlights a novel sequela of gall bladder disease in this species, and biliothorax should be a differential diagnosis for pleural effusion in cats with evidence of cholecystitis or triaditis.

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“…[1,2,3,4,5] On rare occasions, spontaneous bilio-pleural fistula does occur in patients with gall stones. [6] Rarely bile can reach di-endoscopy. The case was managed actively using non operative modalities and is an established approach in BPF.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Bilio-Pleural Fistula following Thoracoabdominal Trauma

Nikumbh¹,

Barot²,

Kurlekar³

et al. 2018

OGH Reports

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Penetrating thoracoabdominal trauma, with potential injury to two anatomic cavities, poses a significant diagnostic and therapeutic challenge. This is especially true with reference to detection of diaphragmatic injuries, where development of a bilio-pleural fistula is a rare phenomenon. The optimal management in such cases has not been clearly defined as both conservative and emergency surgical approaches have been tried in acute settings. We report a patient who suffered an accidental penetrating wound to the right thoracoabdominal region. The patient developed a bilio-pleural fistula immediately following the injury with imaging showing an intact diaphragm. The case was managed conservatively using endoscopy as the primary modality for treating the primary condition as well as a rare complication of biliary stent migration. Thus an endoscopic approach is feasible in management of bilio-pleural fistula when used in properly selected cases.

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Cholecystopleural Fistula with Cholelithiasis Presenting as a Right Pleural Effusion

Cited by 27 publications

References 5 publications

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

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

Spontaneous cholecystopleural fistula leading to biliothorax and sepsis in a cat

Endoscopic Management of Bilio-Pleural Fistula following Thoracoabdominal Trauma

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