case_images: PMC10898819_01
case_images: Anteroposterior chest X-ray showing right-sided multifocal pneumonia
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case_images: PMC10898819_01_cureus-0016-00000053110-i01.jpg
case_images: FIG1
case_images: CBD stenting, type 2 diabetes, and bipolar disorder presented to the Emergency Department (ED) with chief complaints of productive cough, dyspnea on exertion and at rest, nausea, and vomiting for three days. Chest X-ray revealed right-sided multifocal pneumonia (Figure 1).
case_images: Abdominal ultrasound showing (A) intrahepatic biliary dilation and (B) gallstone at the neck of the gall bladder
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case_images: PMC10898819_01_cureus-0016-00000053110-i02.jpg
case_images: FIG2
case_images: During the ICU course, bronchoscopy revealed right and left main bronchi coated with copious amounts of bilious appearing fluid, and abdominal ultrasound showed intrahepatic biliary dilation and gallstone at the neck of the gallbladder (Figure 2).
case_images: Axial CT image of the abdomen and pelvis without contrast demonstrating (A) multilobar consolidations and (B) stone in the gallbladder neck. CT, computed tomography
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case_images: PMC10898819_01_cureus-0016-00000053110-i03.jpg
case_images: FIG3
case_images: A contrast-enhanced CT of the chest, abdomen, and pelvis showed multilobar consolidations, cholelithiasis with gall bladder wall thickening, a 1.5-cm cholelith in the gallbladder neck, and no fistulous tract between the trachea and esophagus (Figure 3).
case_images: HIDA scan showing activity in the right chest indicating BBF. BBF, bronchobiliary fistula; HIDA, hepatobiliary iminodiacetic acid scan.
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case_images: PMC10898819_01_cureus-0016-00000053110-i04.jpg
case_images: FIG4
case_images: A plastic stent placement for bronchobiliary fistula
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case_images: PMC10898819_01_cureus-0016-00000053110-i05.jpg
case_images: FIG5
case_images: A plastic stent was then deployed for the management of the BBF (Figure 5).
case_images: Percutaneous cholecystostomy tube placement
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case_images: PMC10898819_01_cureus-0016-00000053110-i06.jpg
case_images: FIG6
case_images: On HD 6, the patient underwent successful percutaneous cholecystostomy tube (PCT) placement (Figure 6).
case_images: HIDA scan showing closure of the BBF. BBF, bronchobiliary fistula; HIDA, hepatobiliary iminodiacetic acid
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case_images: PMC10898819_01_cureus-0016-00000053110-i07.jpg
case_images: FIG7
case_images: At his four-week follow-up at the outpatient clinic, a repeat HIDA scan demonstrated closure of the BBF (Figure 7).