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Bilothorax Following Percutaneous Transhepatic Biliary Drainage for Cholangiocarcinoma: Recognising the Depth of Pleural Reflections
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Bilothorax Following Percutaneous Transhepatic Biliary Drainage for Cholangiocarcinoma: Recognising the Depth of Pleural Reflections
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Journal Article
Bilothorax Following Percutaneous Transhepatic Biliary Drainage for Cholangiocarcinoma: Recognising the Depth of Pleural Reflections
2025
Overview
Percutaneous transhepatic biliary drainage (PTBD) is commonly used to relieve biliary obstruction when endoscopic methods are not suitable. Bilothorax, accumulation of bile in the pleural cavity, is a rare but serious complication of PTBD as the procedure can inadvertently breach the pleura, potentially allowing bile to drain into the pleural cavity. This report describes an 82‐year‐old woman with cholangiocarcinoma who developed bilothorax following PTBD due to transpleural puncture associated with a kinked biliary catheter. Pleural fluid analysis confirmed bilothorax, and a drain exchange led to clinical and biochemical improvement. The case underscores a critical anatomical consideration: the pleural cavity extends further caudally than the lung margins and may be violated during any percutaneous intervention. Failure to account for the diaphragmatic pleural reflection depth may result in unintended pleural injury and fluid accumulation. Proceduralists must incorporate detailed pre‐procedural imaging and anatomical awareness to reduce transpleural complications across a range of percutaneous interventions. This report details the case of a patient with cholangiocarcinoma who developed a bilothorax following percutaneous transhepatic biliary drainage (PTBD). Imaging confirmed that a kinked biliary drain had transgressed the pleural reflection, resulting in bile accumulation within the pleural cavity. Although bilothorax is an uncommon complication of hepatobiliary procedures, this case underscores a critical and under‐recognised anatomical vulnerability: the extent of the diaphragmatic pleural reflection, which can extend far below the inferior border of the lung, particularly in the posterior and lateral thoracic regions.
Publisher
John Wiley & Sons, Ltd,John Wiley & Sons, Inc,Wiley
