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Seong, Kim, Yoo, Park, An, Choe, Lee, and Kim: A Case of Cholethorax Developed by Unknown Cause
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 70(3): 261-265.

Published online: 31 March 2011

DOI: https://doi.org/10.4046/trd.2011.70.3.261

A Case of Cholethorax Developed by Unknown Cause

Mun Hyuk Seong, M.D.1, Sung Moo Kim, M.D.1, Suk Hee Yoo, M.D.1, Woo Ri Park, M.D.1, Jin Young An, M.D.1, Kang Hyeon Choe, M.D.1, Ki Man Lee, M.D.1, Si Wook Kim, M.D.2

1Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.

2Department of Thoracic and Cardiovascular Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.

Address for correspondence: Ki Man Lee, M.D. Division of Pulmonology, Department of Internal Medicine, Chungbuk National University Hospital, 410, Sungbong-ro, Heungduk-gu, Cheongju 361-711, Korea. Phone: 82-43-269-6353, Fax: 82-43-269-3252, kimlee@chungbuk.ac.kr

Received 22 October 2010       Accepted 17 December 2010

Copyright © 2011. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

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.

Keywords: Bile, Biliary Fistula, Pleural Effusion, Diaphragm

Figures and Tables

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).
trd-70-261-g004

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