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Updated: Mar 15, 2026
03:22
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
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A new diagnostic approach for bilious pleural effusion.
Takeshi Saraya1, Richard W Light2, Sho Sakuma1
1Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan.
Respiratory Investigation
|August 28, 2016
Summary
Diagnosing bilious pleural effusion, a rare condition, is improved by combining bilirubin ratio tests with pleural glycocholic acid measurement. This combined approach achieves 100% diagnostic sensitivity for this rare liver disease complication.
Area of Science:
- Medical Diagnostics
- Gastroenterology
- Pulmonology
Background:
- Bilious pleural effusion is a rare complication linked to liver diseases, abscesses, biliary peritonitis, and invasive procedures.
- Current diagnosis relies on the pleural to serum bilirubin ratio (>1), but its diagnostic yield is unevaluated due to low incidence.
Purpose of the Study:
- To evaluate the diagnostic yield of the bilirubin ratio test for bilious pleural effusion.
- To identify improved diagnostic criteria for bilious pleural effusion.
Main Methods:
- Retrospective review of institutional medical records.
- PubMed database search for reported cases of bilious pleural effusion.
Main Results:
- Twelve cases of bilious pleural effusion were identified (9 from literature, 3 from institution).
- Causes included liver diseases, subhepatic/subphrenic abscess/biliary peritonitis, and iatrogenic factors.
- The bilirubin ratio test had 76.9% sensitivity; combining it with pleural glycocholic acid achieved 100% sensitivity.
Conclusions:
- A combination of pleural to serum bilirubin ratio (>1) and pleural glycocholic acid presence offers high diagnostic yield.
- This dual-criterion approach enhances the diagnosis of bilious pleural effusion.
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