When the pleural fluid appears in an unexpected color: a bilothorax case

Year 2025, Volume: 18 Issue: 1, 20 - 20

Nilüfer Yiğit , Ali Rıza Kük , Kamil Fatih Türker , Göksel Altınışık Ergur

https://doi.org/10.31362/patd.1487005

Abstract

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 right-sided 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.

Keywords

Bilothorax, unilateral pleural effusion, biliopleural fistula

Plevra sıvısının beklenmedik renkte görünmesi: bilotoraks olgusu

Abstract

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.

Keywords

Bilotoraks, tek taraflı plevral efüzyon, biliyoplevral fistül

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