SHM Converge Scientific Abstract ePoster Gallery-Bile in the Chest: A Call for Rapid Intervention

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This case describes a 77-year-old man with hypertension, hyperlipidemia, prior stroke, subarachnoid hemorrhage, and a ventriculoperitoneal shunt who presented with five days of fever and altered mental status. The initial concern was an infected shunt, but cerebrospinal fluid studies were noninfectious. Further imaging revealed acute cholecystitis and a liver abscess, which were treated with abscess drainage and percutaneous cholecystostomy tube placement.<br /><br />During hospitalization, the patient developed worsening hypoxia and a persistent large right pleural effusion. Diuresis did not improve the effusion, and thoracentesis was incomplete. Pleural fluid testing showed elevated bilirubin, confirming bilothorax, defined as bile in the pleural space and diagnosed when the pleural fluid-to-serum bilirubin ratio exceeds 1.0. Bilothorax is rare and may occur from diaphragmatic defects or as an iatrogenic complication after hepatobiliary procedures.<br /><br />Although the patient later became clinically stable and was asymptomatic on room air, an interdisciplinary team recommended further intervention because of the risk of secondary infection, empyema, and sepsis. A chest tube was placed, and the patient was discharged after tube removal with a six-week course of antibiotics.<br /><br />The key message is that bilothorax is an uncommon but serious complication that can follow biliary procedures such as cholecystostomy. Because pleural bilirubin is not routinely measured, diagnosis requires a high index of suspicion. Prompt drainage and early broad-spectrum antibiotics are essential to prevent deterioration.

Asset Subtitle

Charita Kunta

Meta Tag

Author List Charita Kunta, Madeline Cook, Wanna Zhang

Category Clinical Vignettes

Concept Bilothorax

Concept Pleural Fluid-to-Serum Bilirubin Ratio

Concept Bilirubin

Concept Pleural Fluid

Concept Pleural Effusion

Distinguished Non-Finalist

Presenter Organization Rush University Medical Center

Presenting Author Charita Kunta

Track Adult

Keywords

bilothorax

cholecystitis

liver abscess

pleural effusion

cholecystostomy

thoracentesis

bilirubin ratio

hepatobiliary procedures

chest tube

broad-spectrum antibiotics

Bilothorax

Pleural Fluid-to-Serum Bilirubin Ratio

Bilirubin

Pleural Fluid

Pleural Effusion