Bilotoraks, plevral boşlukta safra varlığı ile karakterize, eksüdatif plevral efüzyonun nadir bir nedenidir. Bu
durumun tanınması ampiyem ve akut solunum sıkıntısı sendromu gibi ciddi komplikasyonları önlemek için
önemlidir. Bu raporda, birçok safra yolu müdahalesi sonrasında sağ taraflı bilotoraks gelişen 70 yaşındaki
bir erkek hasta sunulmaktadır. Hasta sarılık, ateş ve karın ağrısı şikayetleri ile başvurdu. Klinik ve radyolojik
değerlendirme ile sağ taraflı plevral efüzyon görüldü ve torasentez ile koyu sarı-yeşil sıvı elde edildi plevral
mayii/serum total bilirubin oranının >1,0 olması ile bilotoraks tanısı konuldu. Erken müdehale ie sistofix ile plevral
mayi drenajı sağlandı. Ancak tüm müdehalelere rağmen sepsis tablosunun önüne geçilemeyerek hastamız
kaybedildi. Bilotoraks, genellikle hepatobiliyer prosedürlerle ilişkilidir ve anatomik yakınlık nedeniyle çoğunlukla
sağ tarafta görülür. Tanı, özellikle ilgili klinik öykülere ve karakteristik plevral sıvı görünümüne sahip hastalarda
yüksek şüphe gerektirir. Tanı için hızlı torasentez ve plevral sıvı analizi kritik öneme sahiptir. Tedavi genellikle
plevral drenaj ve geniş spektrumlu antibiyotiklerin erken uygulanmasını içerir. Sonuç olarak Bilotoraks, acil tanı
ve müdahale gerektiren hayatı tehdit eden bir durumdur. Bu olgu, ilgili hepatobiliyer öyküye sahip hastalarda bu
nadir durumu tanımanın ve erken agresif yönetimin önemini vurgulamaktadır.
1. Addas R, Alsabban A, Fallatah A, Binaqeel A, Bafageeh S, Bawazir A. Bilothorax a rare incidence in thoracic surgery: case report and literature review. Open J Thorac Surg 2021;11:76-82. https://doi.org/10.4236/ojts.2021.113010
2. Ravikumar DB, Sivasubramanian BP, Dominic Savio FV, Gunendran T, Shekar SP. A green surprise: bilateral bilious pleural effusion secondary to esophageal rupture—a case report. Journal of Investigative Medicine High Impact Case Reports 2024;12. https://doi.org/10.1177/23247096241231634
3. Saraya T, Light RW, Sakuma S, et al. A new diagnostic approach for bilious pleural effusion. Respiratory Investigation 2016;54:364-368. https://doi.org/10.1016/j.resinv.2016.03.009
4. Çoşğun İ, Kıter G, Karabulut N, Türk F, Altun M, Evyapan F. A rare cause of pleural effusion: biliopleural fistula. Solunum 2013;15:194-197. https://doi.org/10.5152/solunum.2013.039
5. Reddy VD, Al Khateeb A, Hussain M, Patel V, et al. Case Report: kryptonite—A rare case of left-sided bilothorax in a sickle cell patient". Case Rep Pulmonol 2019;2019:8658343. https://doi.org/10.1155/2019/8658343
6. Temitope O, Nathan S. Bilothorax: a rare complication of percutaneous transhepatic biliary drainage in a patient with primary sclerosing cholangitis. ACG Case Reports Journal 2024;11:p e01326. https://doi.org/10.14309/crj.0000000000001326
7. Shah K, Ravikumar N, Uddin QK, McGee W, Farmer MJS. Bilateral bilothorax: an unusual cause of bilateral exudative pleural effusion. Cureus 2019;11:e5185. https://doi.org/10.7759/cureus.5185
8. Briones Gómez A, Sánchez Samblancat M, Bekki A. A rare presentation of bilothorax. Archivos de Bronconeumología 2023;59:447-448. https://doi.org/10.1016/j.arbres.2023.03.023
9. Basu S, Bhadani S, Shukla VK. A dangerous pleural effusion. Ann R Coll Surg Engl. 2010;92:53-54. https://doi.org/10.1308/147870810X12699662980637
10. Shen TC, Chen CH, Lai HC, et al. Risk of empyema in patients with chronic liver disease and cirrhosis: a nationwide, population-based cohort study. Liver Int 2017;37:862-870. https://doi.org/10.1111/liv.13330
11. Arvaniti V, D'Amico G, Fede G, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010;139:1246-1256.e5. https://doi.org/10.1053/j.gastro.2010.06.019
12. Cooper AZ, Gupta A, Odom SR. Conservative management of a bilothorax resulting from blunt hepatic trauma. Ann Thorac Surg 2012;93:2043-2044. https://doi.org/10.1016/j.athoracsur.2011.11.024
13. Austin A, Fox N, Huggins JT, Chopra, A. The green pleural effusion: a comprehensive review of the bilothorax with case series. The Official Journal of the International Society of Pleural Diseases. Pleura 2017;4:21-31. https://doi.org/10.1016/j.amjms.2017.03.034
When the pleural fluid appears in an unexpected color: a bilothorax case
Bilothorax, or cholethorax, is a rare cause of exudative pleural effusion characterized by the presence of bile
in the pleural space. Recognizing this condition is essential to prevent severe complications such as empyema
and acute respiratory distress syndrome. This report presents a 70-year-old male patient who developed rightsided
bilothorax following multiple biliary tract interventions. The patient presented with symptoms of jaundice,
fever, and abdominal pain. Clinical and radiological evaluations revealed right-sided pleural effusion, and
thoracentesis yielded dark yellow-green fluid. The diagnosis of bilothorax was confirmed by a pleural fluid/serum
total bilirubin ratio >1.0. Early intervention was performed using a cystofix to drain the pleural fluid. However,
despite all interventions, the sepsis condition could not be controlled, and the patient unfortunately passed
away. Bilothorax is generally associated with hepatobiliary procedures and is mostly observed on the right side
due to anatomical proximity. Diagnosis requires a high index of suspicion, especially in patients with relevant
clinical histories and characteristic pleural fluid appearance. Rapid thoracentesis and pleural fluid analysis are
crucial for diagnosis. Treatment typically involves pleural drainage and early administration of broad-spectrum
antibiotics. In conclusion, bilothorax is a life-threatening condition requiring urgent diagnosis and intervention.
This case highlights the importance of recognizing this rare condition and the necessity for early aggressive
management in patients with a history of hepatobiliary procedures.
1. Addas R, Alsabban A, Fallatah A, Binaqeel A, Bafageeh S, Bawazir A. Bilothorax a rare incidence in thoracic surgery: case report and literature review. Open J Thorac Surg 2021;11:76-82. https://doi.org/10.4236/ojts.2021.113010
2. Ravikumar DB, Sivasubramanian BP, Dominic Savio FV, Gunendran T, Shekar SP. A green surprise: bilateral bilious pleural effusion secondary to esophageal rupture—a case report. Journal of Investigative Medicine High Impact Case Reports 2024;12. https://doi.org/10.1177/23247096241231634
3. Saraya T, Light RW, Sakuma S, et al. A new diagnostic approach for bilious pleural effusion. Respiratory Investigation 2016;54:364-368. https://doi.org/10.1016/j.resinv.2016.03.009
4. Çoşğun İ, Kıter G, Karabulut N, Türk F, Altun M, Evyapan F. A rare cause of pleural effusion: biliopleural fistula. Solunum 2013;15:194-197. https://doi.org/10.5152/solunum.2013.039
5. Reddy VD, Al Khateeb A, Hussain M, Patel V, et al. Case Report: kryptonite—A rare case of left-sided bilothorax in a sickle cell patient". Case Rep Pulmonol 2019;2019:8658343. https://doi.org/10.1155/2019/8658343
6. Temitope O, Nathan S. Bilothorax: a rare complication of percutaneous transhepatic biliary drainage in a patient with primary sclerosing cholangitis. ACG Case Reports Journal 2024;11:p e01326. https://doi.org/10.14309/crj.0000000000001326
7. Shah K, Ravikumar N, Uddin QK, McGee W, Farmer MJS. Bilateral bilothorax: an unusual cause of bilateral exudative pleural effusion. Cureus 2019;11:e5185. https://doi.org/10.7759/cureus.5185
8. Briones Gómez A, Sánchez Samblancat M, Bekki A. A rare presentation of bilothorax. Archivos de Bronconeumología 2023;59:447-448. https://doi.org/10.1016/j.arbres.2023.03.023
9. Basu S, Bhadani S, Shukla VK. A dangerous pleural effusion. Ann R Coll Surg Engl. 2010;92:53-54. https://doi.org/10.1308/147870810X12699662980637
10. Shen TC, Chen CH, Lai HC, et al. Risk of empyema in patients with chronic liver disease and cirrhosis: a nationwide, population-based cohort study. Liver Int 2017;37:862-870. https://doi.org/10.1111/liv.13330
11. Arvaniti V, D'Amico G, Fede G, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010;139:1246-1256.e5. https://doi.org/10.1053/j.gastro.2010.06.019
12. Cooper AZ, Gupta A, Odom SR. Conservative management of a bilothorax resulting from blunt hepatic trauma. Ann Thorac Surg 2012;93:2043-2044. https://doi.org/10.1016/j.athoracsur.2011.11.024
13. Austin A, Fox N, Huggins JT, Chopra, A. The green pleural effusion: a comprehensive review of the bilothorax with case series. The Official Journal of the International Society of Pleural Diseases. Pleura 2017;4:21-31. https://doi.org/10.1016/j.amjms.2017.03.034
Yiğit N, Kük AR, Türker KF, Altınışık Ergur G. When the pleural fluid appears in an unexpected color: a bilothorax case. Pam Med J. July 2024;18(1):227-231. doi:10.31362/patd.1487005