Biliopleural fistula with cholethorax. A rare complication of percutaneous transhepatic biliary drainage

Biliopleural fistula leading to cholethorax formation is a rare complication of percutaneous transhepatic cholangiography (PTC). Ideally it should be treated conservatively as it closes spontaneously in most patients. However, in complicated cases it may require surgical intervention. We report a 35-year-old male with right biliopleural fistula with cholethorax following PTC. The patient complained of shortness of breath, right pleuritic chest pain, and cough after removal of PTC catheter. Chest radiograph showed an extensive right pleural effusion. The diagnosis was confirmed by drainage of dark green pleural fluid with high bilirubin content. The initial treatment with chest tube and drainage was unsuccessful. He underwent video assisted thoracoscopic intervention. Diagnostic modalities and management options for biliopleural fistula are discussed along with a review of literature.