Thoracoscopic diagnosis of pleurolithiasis after laparoscopic cholecystectomy

We describe a patient with right pleuritic chest pain and an enlarging exudative pleural effusion four months after laparoscopic cholecystectomy. Several radiographic imaging procedures and thoracenteses were nondiagnostic. Thoracoscopy, however, revealed bilious concretions in the parietal pleura. Thoracoscopic drainage, lysis of adhesions, and antibiotic treatment of a Klebsiella pneumoniae pleuritis resulted in relief of symptoms.