A Case of Cholethorax Developed by Unknown Cause

Cholethorax is a bilious pleural effusion caused by a pleurobiliary fistula or leakage of bile into the pleural space. Most cases of cholethorax arise from a complication of abdominal trauma, hepatobiliary infection, or invasive procedures or surgery of hepatobiliary system. However, we experienced a case of a patient with cholethorax of unknown origin. There was no evidence of pleurobiliary fistula or leakage of bile from the hepatobiliary system although we examined the patient with various diagnostic tools including chest and abdominal computed tomography, endoscopic retrograde cholangiopancreatography, tubography, bronchofiberscopy, hepatobiliary scintigraphy and video-assisted thoracoscopic surgery. Herein we report a case of cholethorax for which the specific cause was not identified. The patient was improved by percutaneous drainage of pleural bile.

keywords: Bile, Biliary Fistula, Pleural Effusion, Diaphragm, Bile, Biliary Fistula, Pleural Effusion, Diaphragm

Reference

1. Amir-Jahed AK, Sadrieh M, Farpour A, Azar H, Namdaran F. Thoracobilia: a surgical complication of hepatic echinococcosis and amebiasis. Ann Thorac Surg 1972;14:198-205.

2. Franklin DC, Mathai J. Biliary pleural fistula: a complication of hepatic trauma. J Trauma 1980;20:256-8.

3. Strange C, Allen ML, Freedland PN, Cunningham J, Sahn SA. Biliopleural fistula as a complication of percutaneous biliary drainage: experimental evidence for pleural inflammation. Am Rev Respir Dis 1988;137:959- 61.

4. Ichikawa T, Yamada T, Takagi H, Abe T, Ito H, Sakurai S, et al. Transcatheter arterial embolization-induced bilious pleuritis in a patient with hepatocellular carcinoma. J Gastroenterol 1997;32:405-9.

5. Oparah SS, Mandal AK. Traumatic thoracobiliary (pleurobiliary and bronchobiliary) fistulas: clinical and review study. J Trauma 1978;18:539-44.

6. Light RW, Lee G. Textbook of pleural diseases. 2nd ed. London: Hodder Arnold; 2008.

7. Lee SH, Lee KJ, Kim SY, Lee SK, Jung KS, Park BH, et al. Bilioptysis caused by bronchobiliary fistula secondary to sclerosing therapy of liver cyst. Tuberc Respir Dis 2010;69:119-23.

8. Park CS, Lee SJ, Do GW, Oh SY, Cho H, Kim MS, et al. A case of cholethorax following percutaneous transhepatic cholangioscopy. Tuberc Respir Dis 2008;65: 131-6.

9. Feld R, Wechsler RJ, Bonn J. Biliary-pleural fistulas without biliary obstruction: percutaneous catheter management. AJR Am J Roentgenol 1997;169:381-3.

10.

10. Sheik-Gafoor MH, Singh B, Moodley J. Traumatic thoracobiliary fistula: report of a case successfully managed conservatively, with an overview of current diagnostic and therapeutic options. J Trauma 1998;45:819-21.

11.

11. Brunaud L, Sebbag H, Bresler L, Tortuyaux JM, Boissel P. Left hepatic duct injury and thoracobiliary fistula after abdominal blunt trauma. Hepatogastroenterology 2000;47:1227-9.

12.

12. Rowe PH. Bilothorax--an unusual problem. J R Soc Med 1989;82:687-8.

13.

13. Pisani RJ, Zeller FA. Bilious pleural effusion following liver biopsy. Chest 1990;98:1535-7.

14.

14. Córdoba López A, Monterrubio Villar J, Bueno Alvarez- Arenas I. Biliothorax unrelated to fistula: a rare complication in gallbladder disease. Arch Bronconeumol 2008;44:396-7.

15.

15. Sewell CM, Clarridge JE, Young EJ, Guthrie RK. Clinical significance of coagulase-negative staphylococci. J Clin Microbiol 1982;16:236-9.

바로가기메뉴

Article Contents

Vol.70 No.3

A Case of Cholethorax Developed by Unknown Cause

Abstract

Reference

Tuberculosis & Respiratory Diseases