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

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.

Bilothorax as a complication of endoscopic retrograde cholangiopancreatography: A rare case report and literature review.

INTRODUCTION: Bilothorax is a rare and poorly documented condition in the medical literature, with following hepatobiliary procedures being the most common cause. We present a case of bilothorax following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. CASE PRESENTATION: A 71-year-old woman with a history of prior percutaneous biliary stone removals presented with Charcot's triad and was diagnosed with cholangitis due to a distal common bile duct stone. She underwent ERCP with successful stone extraction and stent placement. Two days later, she developed a right-sided pleural effusion diagnosed as a post-ERCP bilothorax. She was treated with thoracentesis and antibiotics, and her condition significantly improved. After 15 days, she was discharged, and a one-month follow-up showed no complications or recurrence. CLINICAL DISCUSSION: Bile is a potent chemo irritant that can cause adhesive pleurodesis. Besides, accompanying cholangitis can lead to pleural infection and empyema. In this patient, early diagnosis leading to timely pleural drainage decisions helped avoid potential consequences. CONCLUSION: Post-ERCP bilothorax is a rare complication but can lead to severe consequences. Nonoperative management by pleural drainage is a safe and effective strategy if diagnosis is made early, helping patients avoid more invasive interventions.

Spontaneous bilothorax without previous surgery or trauma, a case report.

Bilothorax is a rare condition that can lead to severe infection and death. Most cases present with right-sided pleural effusion and the etiology can be biliary obstruction, infection, or iatrogenic complications. The diagnosis of bilothorax is confirmed by the ratio of pleural fluid to serum bilirubin >1. A 33-year-old Asian female presented with progressive dyspnea from right pleural effusion, which was confirmed to be biloma by pleural fluid to serum bilirubin ratio of 15.9. Imaging showed right-sided subdiaphragmatic nodule, which was subsequently biopsied on laparoscopy revealing hemorrhagic endometriotic lesion. However, there was no obvious diaphragmatic defect connecting pleural and peritoneal cavities. Additionally, no biliary leakage was identified by magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). The treatment included antibiotics, tube thoracostomy, ERCP with stent, thermal ablation of endometriotic nodules under laparoscopy, and hormonal therapy for endometriosis. Bilothorax is rare case itself but the etiology secondary to endometriosis makes this case particularly unique.

A Green Surprise: Bilateral Bilious Pleural Effusion Secondary to Esophageal Rupture-A Case Report.

Bilothorax, an exudative pleural effusion due to the accumulation of bile. It is also called cholethorax or thoracobilia and was initially reported in 1971. Here, we report a rare case of an elderly male presenting with bilateral bilothorax due to esophageal rupture. A 78-year-old man with multiple medical ailments presented to the emergency room (ER) with a severe episode of vomiting accompanied by a popping sound, respiratory distress, and right sided chest pain. The patient had tachycardia, BP of 101/89 mm Hg, and tachypnea. Computed tomography scan of the chest and abdomen revealed air adjacent to the esophagus, suggesting perforation, atelectasis of right lung, and bilateral pleural effusion (R > L). However, an esophagram did not reveal any perforation. Right-sided chest tube drained dark green bilious fluid. The day after admission, he experienced hemodynamic compromise and hypoxemia requiring intubation, along with fluids and inotropes support. Diagnosis of bilateral bilothorax complicated by hypoxemic respiratory failure with septic shock was made. Cultures were drawn, and empiric antibiotics were started. Nuclear hepatobiliary scan (HIDA) was performed to rule out a hepatobiliary fistula. Results showed reflux activity in the stomach, and distal esophageal leak was identified. Gastrojejunal stenting was performed. However, after prolonged intubation, the family decided on terminal extubation, and he died while receiving hospice care. This case highlights the rarity of bilateral bilothorax, where the HIDA scan played a crucial role in identifying an esophageal leak as the underlying cause, despite normal esophagram results. This condition necessitates prompt diagnosis and aggressive therapeutic interventions.

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

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.

Canine and Feline Exudative Pleural Diseases.

Exudative pleural diseases are a common cause of respiratory distress and systemic illness in dogs and cats. This article covers the pathophysiology, development, and classification of exudative pleural effusions. The most current diagnostic strategies, causes, imaging findings, and medical or surgical treatment options for select diseases are reviewed in detail.

Bilothorax Associated with Bile Peritonitis in a Dog with No Diaphragmatic Disruption: A Case Report.

A 4-year-old intact male mixed-breed dog was presented with vomiting and severe depression of 6-day duration after being struck by a car 2 weeks before presentation. Clinical examination revealed hypothermia, respiratory difficulty, jaundice, and a bicavitary (pleural and peritoneal) effusion. Hematological and biochemical abnormalities included neutrophilic leukocytosis, increased total bilirubin concentration, and increased serum lipase activity. Biochemical and cytological evaluation of both abdominal and thoracic fluids were suggestive of bilious effusions. During celiotomy, a rupture of the cystic duct was observed, which necessitated cholecystectomy. A diaphragmatic rupture was not found. A thoracostomy tube was inserted in the right pleural space, and continuous suction was maintained for 48 hours. The dog was discharged 20 days after surgery and no abnormalities were detected on either blood tests or ultrasonographic examinations of the thorax and abdomen on follow-up examination 7 months after surgery. The presence of a bilothorax should be considered in animals with bile peritonitis, grossly intact diaphragm and pleural effusion. The exact mechanisms of the development of bilothorax are unclear, but the transport of bile through microscopic congenital or acquired weaknesses or defects of the diaphragm, via abdominal lymphatics penetrating the diaphragm and draining into the thoracic lymphatics represent the most probable route.

Bilateral Bilothorax: An Unusual Cause of Bilateral Exudative Pleural Effusion.

Bilothorax is an uncommon cause of exudative pleural effusion; the majority of reported cases are right-sided while a bilateral presentation is extremely rare. The majority of cases are secondary to biliary obstruction, an extension of hepatic infections, and iatrogenic complications following percutaneous procedures or surgical interventions. Imaging studies and a diagnostic pleural tap can confirm the diagnosis. Early recognition and complete drainage are important to prevent life-threatening complications, including empyema formation. We present a case of a 71-year-old female who developed bilateral bilothorax as a complication of gallstone pancreatitis.

An Interesting Case of a Bilious Pleural Effusion.

Malignant pleural effusions are common complications in patients with primary or metastatic cancer to the lungs. In this article, we describe a unique case of a patient with history of diffuse pulmonary metastases from gallbladder adenocarcinoma who acutely developed a bilious pleural effusion following endoscopic retrograde cholangiopancreatography. We believe the bilious pleural effusion (cholethorax or bilothorax) developed as a complication of endoscopic retrograde cholangiopancreatography rather than tumor burden causing a fistula from the biliary tree to the right pleural space. We discuss possible mechanisms of formation of the bilious pleural effusion in our patient and present a literature review of previously reported cases of bilious pleural effusions.

Occlusion of a Long-Term Transpleural Biliary Drainage Tract Using a Gelatin Pledget (Hep-Plug™).

This case describes a technique used to close a long-term 14F transpleural biliary drainage catheter tract to prevent biliopleural fistula and further complications. We deployed a compressed gelatin foam pledget provided in a pre-loaded delivery device (Hep-Plug™) along the intrahepatic tissue tract for sealing it against the pleural cavity. The device used is easy to handle and gives the Interventional Radiologist the possibility to safely manage and prevent complications after percutaneous transhepatic interventions.

Percutaneous Transhepatic Biliary Drainage Complicated by Bilothorax.

Percutaneous transhepatic biliary drainage (PTBD) is a well-established and safe technique for the management of biliary obstructions and leaks. While approach is variable based on operator preference, patient anatomy, and indications; PTBD is commonly performed via a right-sided intercostal route. With a right-sided approach, pleural complications may be encountered. The authors describe a case of a right PTBD complicated by a leak into the pleural space, with the subsequent development of bilothorax.

Exudative pleural diseases in small animals.

Exudative pleural diseases are a common cause of respiratory distress and systemic illness in dogs and cats. This article addresses the pathophysiology, development, and classification of exudative pleural effusions. The most current diagnostic strategies, causes, imaging findings, and medical or surgical treatment options for select diseases are reviewed in detail.