Abstract
Malignant pleural effusions are common complications in patients with primary or metastatic cancer to the lungs. In this article, we describe a unique case of a patient with history of diffuse pulmonary metastases from gallbladder adenocarcinoma who acutely developed a bilious pleural effusion following endoscopic retrograde cholangiopancreatography. We believe the bilious pleural effusion (cholethorax or bilothorax) developed as a complication of endoscopic retrograde cholangiopancreatography rather than tumor burden causing a fistula from the biliary tree to the right pleural space. We discuss possible mechanisms of formation of the bilious pleural effusion in our patient and present a literature review of previously reported cases of bilious pleural effusions.
Highlights
A 76-year-old man presented with mild abdominal pain, nausea without emesis, and new development of jaundice and dark urine
Available images at the bases of the lungs did not reveal a pleural effusion; previously noted diffuse metastatic disease in his lungs was once again appreciated. He was diagnosed with obstructive jaundice and underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy and subhilar 4 cm ×y 10 mm metal stent placement with confirmed biliary drainage on fluoroscopy (Figure 1)
Surgery is the only van Niekerk et al ERCP with stent placement are low with 3.5% risk of developing pancreatitis, 1.3% risk of hemorrhage, 1% risk of cholangitis, and only 0.6% risk of perforation.[2]
Summary
A 76-year-old man presented with mild abdominal pain, nausea without emesis, and new development of jaundice and dark urine. Available images at the bases of the lungs did not reveal a pleural effusion; previously noted diffuse metastatic disease in his lungs was once again appreciated He was diagnosed with obstructive jaundice and underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy and subhilar 4 cm ×y 10 mm metal stent placement with confirmed biliary drainage on fluoroscopy (Figure 1). Physical exam was significant for new development of decreased breath sounds in the right lower lung fields and mild persistent abdominal pain in the right upper quadrant His laboratory values were significant for a leukocytosis of 21.7 with 87.6% neutrophils, AST 115, ALT 426, total bilirubin 3.1, and alkaline phosphatase 572.
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