Abstract
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.
Investigations. 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.
Diagnosis. Biliopleural fistula with connections between the right pleural space and a branch of the right intrahepatic biliary tree.
Management. 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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Huang, S. F. et al. Liver abscess formation after transarterial chemoembolization for malignant hepatic tumor. Hepatogastroenterology 50, 1115–1118 (2003).
Chang, C. C. et al. Congenital bronchobiliary fistula. Radiology 156, 82 (1985).
Andalkar, M. et al. Bronchobiliary fistula as a complication of liver metastases: diagnosed by HIDA scan. Clin. Nucl. Med. 29, 289–291 (2004).
Navsaria, P. H. et al. Traumatic thoracobiliary fistulae: a case report with a review of the current management options. Injury 33, 639–643 (2002).
Gugenheim, J. et al. Bronchobiliary fistulas in adults. Ann. Surg. 207, 90–94 (1988).
Llovet, J. M. et al. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37, 429–442 (2003).
Wigmore, S. J. et al. Postchemoembolisation syndrome—tumour necrosis or hepatocyte injury? Br. J. Cancer 89, 1423–1427 (2003).
Chua, H. K. et al. Bronchobiliary fistula: principles of management. Ann. Thorac. Surg. 70, 1392–1394 (2000).
Chung, J. W. et al. Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization. Radiology 198, 33–40 (1996).
Sakamoto, I. et al. Intrahepatic biloma formation (bile duct necrosis) after transcatheter arterial chemoembolization. AJR Am. J. Roentgenol. 181, 79–87 (2003).
Hirakawa, M. et al. Gastroduodenal lesions after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Am. J. Gastroenterol. 83, 837–840 (1988).
Liu, C. L. et al. Ruptured hepatocellular carcinoma as a complication of transarterial oily chemoembolization. Br. J. Surg. 85, 512–514 (2003).
Lazaridid, K. N. et al. Hepatic hydrothorax: pathogenesis, diagnosis, and management. Am. J. Med. 107, 262–267 (1999).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Lewis, J., Te, H., Gehlbach, B. et al. A case of biliopleural fistula in a patient with hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol 6, 248–251 (2009). https://doi.org/10.1038/nrgastro.2009.34
Issue Date:
DOI: https://doi.org/10.1038/nrgastro.2009.34
