Tuberc Respir Dis.  2008 Aug;65(2):131-136.

A Case of Cholethorax following Percutaneous Transhepatic Cholangioscopy

• Park CS
• Lee SJ
• Do GW
• Oh SY
• Cho H
• Kim MS
• Hong IK
• Bang SJ
• Jegal YJ
• Ahn JJ
• Seo KW

Abstract

Cholethorax (bilious pleural effusion) is an extravasation of bile into the thoracic cavity via a pleurobiliary fistula (and also a bronchobiliary fistula). It is an extremely rare complication of thoraco-abdominal injuries. It can be caused by congenital anomaly and also by hepatobiliary trauma, severe infection or iatrogenic procedures. The definitive diagnosis is made with aspiration of bilious fluid from the pleural space during thoracentesis, by finding a fistulous tract during endoscopic retrograde cholangiopancreatography (ERCP) or cholagioscopy, or with finding an abnormal pleural accumulation of radioisotope during hepatobiliary nuclear imaging. Its symptoms include coughing, fever, dyspnea and pleuritc chest pain. Herein we report on a case of cholethorax following performance of percutaneous transhepatic cholangioscopy (PTCS) to remove incidentally discovered common bile duct (CBD) stones.

Keyword

Biliary fistula; Pleural effusion; Bile; Cholangiography; Technetium Tc 99m Diethyl-iminodiacetic Acid

MeSH Terms

Bile
Biliary Fistula
Chest Pain
Cholangiography
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct
Cough
Dyspnea
Fever
Fistula
Pleural Effusion
Technetium Tc 99m Diethyl-iminodiacetic Acid
Thoracic Cavity
Technetium Tc 99m Diethyl-iminodiacetic Acid

Figure

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  Figure 1 Follow-up tubography after tract dilatation shows total obstruction of the distal common bile duct (CBD) by a filling defect (arrow), which may be a CBD stone.

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  Figure 2 Chest CT scan shows remnant transhepatic biliary fistula (black arrows) after percutaneous transhepatic cholangioscopy (PTCS) tube removal (A) and right pleural effusion (white arrows) (B).

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  Figure 3 A bottle of fluid shows yellow-brownish bilious fluid from thoracic cavity via chest pigtail catheter.

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  Figure 4 Hepatobiliary scan using 370 MBq of 99mTc-mebrofenin shows the radioactivity in the right pleural space after 30 minutes of injection in anterior view (A) and right lateral view (B) (arrows). After opening the clamp of pigtail catheter which was inserted into the right pleural space, drainage of the accumulated radioactivity is noted (arrowhead).

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