Pleural Effusion-Cholethorax

Epidemiology

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Etiology

  • Trauma: resulting in biliary-pleural fistula
  • Percutaneous Transhepatic Procedures: biliary drainage procedure resulting in accidental iatrogenic creation of biliary-pleural fistula
  • Biliary Surgery: resulting in accidental iatrogenic creation of biliary-pleural fistula
  • Suppurative Biliary Tract Infection (see [[Cholangitis]]): with development of biliary-pleural fistula

Physiology

  • Biliary-pleural fistula

Diagnosis

  • Pleural Fluid:
    • Appearance: usually appears bilious
    • /Pleural:Serum Bili Ratio: >1.0

Clinical

  • Symptoms + Signs of Pleural Effusion: dyspnea
  • Emypema (see [[Pleural Effusion-Parapneumonic]]): incidence of empyema is 50%

Treatment

  • Re-Establishment of Biliary Drainage and/or Diaphragmatic Repair: as required
  • Decortication: may be required

References

  • Cholethorax following Percutaneous Transhepatic Biliary Drainage. Ulster Med J. 2007 May; 76(2): 112–113
  • Franklin DC, Mathai J. Biliary pleural fistula: a complication of hepatic trauma. J Trauma. 1980;20(3):256–62
  • Bamberger PK, Stojadinovic A, Shaked G, Golocovsky M. Biliary-pleural fistula presenting as a massive pleural effusion after thoracoabdominal penetrating trauma. J Trauma. 1997;43(1):162–3
  • 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(2):198–205
  • Dasmahapatra HK, Pepper JR. Bronchopleurobiliary fistula. A complication of intrahepatic biliary stent migration. Chest. 1988;94(4):874–5
  • Liberale G, Delhaye M, Ansay J, Houben JJ, Coppens E, Gelin M, et al. Biliary pleural fistula as a complication of radiofrequency ablation for liver metastasis. Acta Chir Belg. 2004;104(4):448–50
  • Lehur PA, Guiberteau-Canfrere V, Bury A, Cloarec D, Le Borgne J. [“Cholethorax” revealing injury to the common bile duct after celioscopic cholecystectomy]. [French] Ann Chir. 1992;46(5):450–2
  • Pisani RJ, Zeller FA. Bilious pleural effusion following liver biopsy. Chest. 1990;98(6):1535–7
  • Armstrong CP, Taylor TV. Intrapleural leakage of bile complicating percutaneous transhepatic drainage of the obstructed biliary tree. J R Coll Surg Edinb. 1982;27(5):308–9
  • Herschman Z, Amin D, Lehrfield A. Bilious pleural effusion as a complication of attempted percutaneous biliary drainage. Crit Care Med. 1991;19(1):128–9
  • 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(4):959–61