Cholecystopleural fistula as a cause of recurrent infected biliothorax

A cholecystopleural fistula is an extremely rare condition characterized by abnormal communication between the gallbladder and pleural cavity. This abnormal connection can lead to the leakage of bile or infectious material into the pleural space, potentially causing infected biliothorax. Here, we report a case of recurrent infected biliothorax caused by a cholecystopleural fistula in a 77-year-old man. The patient had a history of acute cholecystitis and choledocholithiasis for which endoscopic gallbladder stenting was performed one year earlier. The patient was admitted for fever and right pleural effusion. The chest computed tomography (CT) revealed a linear shadow extending from the gallbladder to the pleural cavity. Abdominal ultrasonography revealed continuity between the gallbladder fundus and right pleural space. In addition, a large highly echogenic area with acoustic shadowing was observed in the right pleural cavity. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed leakage of contrast medium from the atrophied gallbladder into the pleural cavity, confirming the diagnosis of a cholecystopleural fistula. This case underscores the importance of considering biliary disease as a potential cause of recurrent infected biliothorax in patients with a history of cholecystitis or biliary intervention. Imaging modalities such as CT, ERCP, and ultrasonography play a critical role in the accurate diagnosis of this rare but serious condition.