TY - JOUR
TI - Management of massive bilothorax post-percutaneous trans-hepatic biliary
drainage
AU - Vrachliotis, Thomas G.
AU - Spiliopoulos, Stavros
AU - Voros, Dionisios
JO - The Egyptian Journal of Radiology and Nuclear Medicine
PY - 2022
VL - 53
TODO - 1
SP - null
PB - Springer-Verlag
SN - 0378-603X
TODO - 10.1186/s43055-022-00733-z
TODO - Bilothorax; Dyspnea; Percutaneous trans-hepatic biliary drainage
TODO - Background: Iatrogenic bilothorax is an infrequent major complication of
percutaneous trans-hepatic biliary drainage (PTBD) and optimal treatment
remains under-reported. The authors herein describe a case of PTBD
complicated by a massive bilous effusion.
Case presentation: An 80-year-old male underwent PTBD due to malignant
obstructive jaundice (total bilirubin 20.0 mg/dL). Following discharge,
the patient was readmitted with severe dyspnea and recurrence of
jaundice (total bilirubin 15.0 mg/dL). CT depicted the drainage catheter
traversing the right costophrenic sulcus, complete obliteration of the
right pleural space, no aerated right lung parenchyma and left
mediastinal shift. The pleural effusion was successfully drained, and
the biliary drainage catheter tract was sealed with Gelfoam pledgets and
coils, to prevent bilopleural fistula formation and recurrence of the
effusion.
Conclusions: In this case, a successful totally percutaneous management
of iatrogenic bilothorax following PTBD is described. Due to the
potential of rapid clinical deterioration and empyema formation,
immediate evaluation and treatment are warranted. Prompt pleural
drainage with antibiotic therapy and bile flow diversion from the
pleural cavity are required.
ER -