Bilateral Bilothorax: An Unusual Cause of Bilateral Exudative Pleural Effusion

Abstract

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.

Keywords: bilateral bilothorax; pleural effusion.

Figure 1. Left-sided pleural fluid samples showing bile pigments

Figure 2. Ultrasound of the right lung

Bedside ultrasound of the right lung showing complex fluid collection with multiple septations and lung ‘floating’ in pleural fluid

Figure 3. Cholecystogram

Cholecystogram showing the indwelling cholecystostomy catheter (a) in a satisfactory position within the contracted gallbladder lumen (b) and prompt egress of contrast into the duodenum with no evidence of a bile leak

Figure 4. Chest CT scans

Before (1) and after (2) chest computed tomography (CT) images following the administration of alteplase through the left chest tube into the pleural space