A case of biliopleural fistula in a patient with hepatocellular carcinoma.
BACKGROUND
A 66-year-old white man with a history of cryptogenic cirrhosis complicated by hepatocellular carcinoma, ascites and hepatic encephalopathy presented with a productive cough and pleuritic chest pain on his right side. He underwent transarterial chemoembolization for hepatocellular carcinoma 6 months before presentation. The patient had a history of coronary artery disease, type 2 diabetes mellitus and hypertension.


METHODS
Medical history and physical examination, laboratory investigations, diagnostic thoracentesis, bacterial culture and Gram staining studies, abdominal MRI with magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, infused chest CT and examination of the thorax during open thoracotomy.


METHODS
Biliopleural fistula with connections between the right pleural space and a branch of the right intrahepatic biliary tree.


RESULTS
Antibiotics, placement and removal of a chest tube, endoscopic retrograde cholangiopancreatography to guide biliary sphincterotomy with placement and removal of a hepatic-duct stent, open thoracotomy with decortication, percutaneous transhepatic cholangiography and placement of a catheter.
University of Chicago Medical Center, Chicago, IL 60637, USA.
Jeffrey R
JR
Lewis
Helen S
HS
Te
Brian
B
Gehlbach
Aytekin
A
Oto
Jennifer
J
Chennat
Smruti R
SR
Mohanty
D000368:Aged; D001658:Biliary Fistula / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D016156:Respiratory Tract Fistula / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D013908:Thoracotomy