A Rare Cause of Pleural Effusion: Biliopleural Fistula

Abstract

Biliopleural fistula (BPF) is a very rare entity, characterised by a passage between the pleural cavity and biliary system. Our case, a 67-year-old female patient, had undergone a cholecystectomy 2 years previously and complained of a massive right pleural effusion. Pleural fluid samples of thoracentesis obtained was green and we suspected BPF. Pleural fluid/serum total bilirubin ratio was >1.0. Diagnosis of BPF was confirmed by Gadobenate dimeglumine (Gd-BOPTA) contrast-enhanced magnetic resonance cholangiography (MRC). Bile leak of the pleural cavity was blocked using the process of the papillotomiyby Endoscopic retrograde cholian giopancreotography. We present our case to emphasize that BPF is a very rare situation, with the finding of green pleural fluid, confirmation of the diagnosis with Gd-BOPTA contrast-enhanced MRC and treatment with ERCP.