Chronic percutaneous gallstone discharge following videothoracoscopic decortication

Area of Science:

• Thoracic Surgery
• Sepsis Management
• Diagnostic Imaging

Background:

• Current guidelines do not mandate computed tomographic (CT) imaging for pleuro-pulmonary sepsis surgery.
• This approach may lead to overlooking underlying conditions contributing to pleural collections.
• Gallstone disease is a potential, though less common, extra-thoracic cause of such presentations.

Observation:

• A patient underwent video-assisted thoracic surgery for early pleural empyema.
• The empyema was secondary to calculous gallstone disease, which was initially missed.
• Four months post-surgery, gallstones were discharged through a healed intercostal drain site.

Findings:

• Missed diagnosis of gallstone disease led to a complication following thoracic surgery for empyema.
• Spontaneous discharge of gallstones via a thoracic drain site is a rare sequela.
• Computed tomographic imaging's role in evaluating complex pleural collections warrants consideration.

Implications:

• Highlights a potential pitfall of current guidelines regarding imaging in pleuro-pulmonary sepsis.
• Underscores the importance of a high index of suspicion for extra-thoracic causes in right-sided pleural collections.
• Suggests a need for careful patient history evaluation, particularly in those with a history of gallstone disease.