# Biliopleural Fistula Following Percutaneous Transhepatic Drainage: A Rare Cause of Bilious Pleural Effusion

## TL;DR

A rare case of a bile leak into the chest after a liver drainage procedure is reported, emphasizing the need for early diagnosis and treatment to avoid serious complications.

## Contribution

This paper presents a rare clinical case of biliopleural fistula following percutaneous transhepatic drainage.

## Key findings

- Biliopleural fistula can develop after percutaneous transhepatic drainage and may present with bilious pleural effusion.
- MRCP confirmed the presence of a fistulous tract between the biliary system and the pleural space.
- Surgical intervention resolved the condition and confirmed the diagnosis.

## Abstract

Biliopleural fistula is a rare but serious complication of hepatobiliary interventions. It may present with atypical respiratory symptoms and requires a high index of suspicion for diagnosis. We report the case of a 79‑year‑old woman with choledocholithiasis complicated by failed endoscopic retrograde cholangiopancreatography (ERCP), post‑ERCP pancreatitis, and cholangitis. Following percutaneous transhepatic drainage (PTD) with external biliary catheter placement, she developed a loculated right‑sided pleural effusion. Diagnostic thoracentesis revealed bilious pleural fluid, and magnetic resonance cholangiopancreatography (MRCP) confirmed a fistulous tract between the intrahepatic biliary system and the pleural space. Surgical thoracotomy with decortication established the diagnosis and resolved the condition. This case highlights the importance of recognizing biliopleural fistula as a potential complication of PTD. Early imaging and timely surgical intervention are critical to prevent respiratory compromise.