Journal List > Tuberc Respir Dis > v.65(2) > 1001261

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Park, Lee, Do, Oh, Cho, Kim, Hong, Bang, Jegal, Ahn, and Seo: A Case of Cholethorax following Percutaneous Transhepatic Cholangioscopy
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 65(2): 131-136.

Published online: 31 August 2008

DOI: https://doi.org/10.4046/trd.2008.65.2.131

A Case of Cholethorax following Percutaneous Transhepatic Cholangioscopy

Chan Sung Park, M.D.1, Soon Jung Lee, M.D.1, Gi Won Do, M.D.1, Ssang Yong Oh, M.D.1, Hyun Cho, M.D.1, Min Su Kim, M.D.1, Il Ki Hong, M.D.2, Sung-Jo Bang, M.D.1, Yang Jin Jegal, M.D.1, Jong-Joon Ahn, M.D.1, Kwang Won Seo, M.D.1

1Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea.

2Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Kwang Won Seo, M.D. Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3, Jeonhadong, Dong-gu, Ulsan 682-714, Korea. Phone: 82-52-250-7029, Fax: 82-52-251-8235, kwseo@uuh.ulsan.kr

Received 18 June 2008       Accepted 14 July 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

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.

Keywords: Biliary fistula, Pleural effusion, Bile, Cholangiography, Technetium Tc 99m Diethyl-iminodiacetic Acid

Figures and Tables

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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