title: A new diagnostic approach for bilious pleural effusion.
abstract: BACKGROUND
  Bilious pleural effusion is an extremely rare condition associated with liver diseases, subphrenic or subhepatic abscess formation, biliary peritonitis, and invasive procedures (i.e., percutaneous biliary drainage or liver biopsy). The current diagnostic test is based on the measurement of the ratio of pleural total bilirubin to serum total bilirubin, which is greater than 1 in patients with bilious pleural effusion. Given the low incidence of bilious pleural effusion, the precise diagnostic yield of this ratio based test has not been evaluated.
  
  
  METHODS
  We retrospectively reviewed the medical records of our institution and searched the PubMed database for reports of bilious pleural effusion.
  
  
  RESULTS
  We identified a total of 12 cases of bilious pleural effusion (9 from 8 Pubmed reports and 3 from our institutional records). The factors causing this condition were broadly classified into three categories based on the pathophysiology: 1) liver diseases (echinococcosis, tuberculosis and amebiasis); 2) subhepatic/subphrenic abscess or biliary peritonitis, with or without biliary tract obstruction; and 3) iatrogenic disease after percutaneous biliary drainage and/or liver biopsy. The sensitivity of detection was 76.9% when the ratio of pleural total bilirubin to serum total bilirubin was greater than 1. The sensitivity increased to 100% when a combination test including pleural glycoholic acid was adopted.
  
  
  CONCLUSIONS
  This study demonstrates the high diagnostic yield for bilious pleural effusion using a combination of two test criteria; a ratio of pleural total bilirubin to serum total bilirubin greater than 1 and the presence of pleural glycoholic acid.
authors: Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan. Electronic address: sara@yd5.so-net.ne.jp.
authors: Takeshi
authors: T
authors: Saraya
authors: Division of Allergy/Pulmonary/Critical Care, Vanderbilt University Medical Center, 1161 21st Ave. S., C-1206, Nashville, TN 37232-2650, USA. Electronic address: rlight98@yahoo.com.
authors: Richard W
authors: RW
authors: Light
authors: Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan.
authors: Sho
authors: S
authors: Sakuma
authors: Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan.
authors: Yasuo
authors: Y
authors: Nakamoto
authors: Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan.
authors: Shoko
authors: S
authors: Wada
authors: Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan.
authors: Manabu
authors: M
authors: Ishida
authors: Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan.
authors: Toshiya
authors: T
authors: Inui
authors: Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan.
authors: Takashi
authors: T
authors: Koide
authors: Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan.
authors: Haruyuki
authors: H
authors: Ishii
authors: Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan.
authors: Hajime
authors: H
authors: Takizawa
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000032:analysis* / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000175:diagnosis*; D012189:Retrospective Studies
chemical_list: D001663:Bilirubin
keywords: Bilious pleural effusion; Glycoholic acid; Pathophysiology; Ratio of pleural total bilirubin to serum total bilirubin