Unexpected color appearance of pleural fluid: a bilothorax case

Year 2025, Volume: 18 Issue: 1, 227 - 231, 01.01.2025

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 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.

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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