Tuberc Respir Dis.  2011 Mar;70(3):261-265. 10.4046/trd.2011.70.3.261.

A Case of Cholethorax Developed by Unknown Cause

• Seong MH
• Kim SM
• Yoo SH
• Park WR
• An JY
• Choe KH
• Lee KM
• Kim SW

• KMID: 1442858
• DOI: http://doi.org/10.4046/trd.2011.70.3.261

Abstract

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.

Keyword

Bile; Biliary Fistula; Pleural Effusion; Diaphragm

MeSH Terms

Bile
Biliary Fistula
Cholangiopancreatography, Endoscopic Retrograde
Diaphragm
Drainage
Fistula
Humans
Pleural Effusion
Thoracic Surgery, Video-Assisted
Thorax

Figure

• 

  Figure 1 (A) Chest X-ray shows right pleural effusion. (B) Chest CT scan shows large amount of pleural effusion with passive atelectasis. (C) Abdomen CT scan shows mild intrahepatic duct dilatation (arrows). CT: computer tomography.

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  Figure 2 Percutaneously needle aspirated pleural effusion was dark greenish colored fluid.

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  Figure 3 (A) The retrograde cholangiopanrceatography shows no evidence of stricture, obstruction of biliary tree or leakage of contrast media. (B) Retrograde cholangiography shows no evidence of biliary tree abnormality or leakage of contrast media. (C) Contrast media injected into pleural cavity via Pigtail cathether. There is no evidence of fistula or leakage of contrast media into extrapleural space.

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  Figure 4 Video assisted thoracic surgery shows severe thickening of pleura with multiple adhesions. Star indicates right diaphragm and bile stained visceral pleura was seen at right upper lobe (triangle) and right lower lobe (arrow).

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