Bilioptysis as a Diagnostic Cornerstone for Occult Bronchobiliary Fistula

Bilioptysis is a rare clinical entity characterized by the expectoration of biliary secretions through the respiratory tract. Its presence is pathognomonic of a biliopulmonary or bronchobiliary fistula. We present the case of a 69-year-old man with a history of ileal carcinoid tumor with metastatic liver disease, who underwent hepatectomy and had a history of abdominal biliary collections. The patient was admitted for bibasal cavitary pneumonia associated with acute respiratory failure. During the clinical course, the patient developed bilioptysis, whose final diagnosis could be confirmed by imaging and bronchoscopic studies. The etiopathogenesis, differential diagnosis, and therapeutic options of this rare complication are discussed.