Biliothorax: A Rare Case of Dyspnea

Abstract

Biliothorax is the presence of bile in the pleural cavity. This condition is rare, and it usually results as a complication of hepatobiliary procedures. The authors present a case of an 87-year-old female who was admitted to the emergency department with the acute onset of severe dyspnea. A chest X-ray and CT revealed a large right-lung pleural effusion that, after thoracentesis, confirmed the presence of biliothorax. It is important to consider this entity when confronted with an effusion liquid of a dark greenish color, as a delay in diagnosis and management may be life-threatening.

Keywords: biliothorax; bilious pleural effusion; emergency department; pulmonary adenocarcinoma; respiratory failure.

Figure 1. Anteroposterior chest X-ray showing extensive right pleural effusion.

Figure 2. A CT with angiography of the chest showing significant right pleural effusion with associated right-lung collapse.

Figure 3. Bilious pleural fluid thoracocentesis sample.

Figure 4. Bilious pleural fluid drainage.