case_images: PMC6604467_01
case_images: Initial chest X-ray demonstrating an isolated left-sided pleural effusion.
case_images: CRIPU2019-8658343.001.jpg
case_images: PMC6604467_01_CRIPU2019-8658343.001.jpg
case_images: fig1
case_images: A chest X-ray revealed an isolated large left pleural effusion (Figure 1).
case_images: A thoracentesis yielded 900 cc of exudative bilious fluid.
case_images: CRIPU2019-8658343.002.jpg
case_images: PMC6604467_01_CRIPU2019-8658343.002.jpg
case_images: fig2
case_images: Thoracentesis was performed revealing 900 cc of green bilious-appearing fluid (Figure 2) with pleural fluid analysis (PFA) showing an elevated pleural bilirubin (3 mg/dL) to serum bilirubin (2.2 mg/dL) ratio greater than 1, confirming the diagnosis of an isolated left-sided bilothorax (Table 1).
case_images: Magnetic resonance cholangiopancreatography (MRCP) showing an acute angle in the mid-common bile duct with upstream dilatation.
case_images: CRIPU2019-8658343.003.jpg
case_images: PMC6604467_01_CRIPU2019-8658343.003.jpg
case_images: fig3
case_images: The distal CBD measured 8 mm (Figure 3).
case_images: Coronal image of an MRCP showing an isolated left intrahepatic duct extending through the left hepatic lobe to the left costophrenic angle.
case_images: CRIPU2019-8658343.004.jpg
case_images: PMC6604467_01_CRIPU2019-8658343.004.jpg
case_images: fig4
case_images: An isolated left intrahepatic duct was seen extending to the distal margin of the left hepatic lobe; however, no clear fistulous connection was seen with the left pleural space (Figure 4).
case_images: Endoscopic retrograde cholangiopancreatography (ERCP) fluoroscopic image showing dilated intrahepatic ducts with absence of filling on the common bile duct (evidenced by the guidewire).
case_images: CRIPU2019-8658343.005.jpg
case_images: PMC6604467_01_CRIPU2019-8658343.005.jpg
case_images: fig5
case_images: An endoscopic retrograde cholangiopancreatography (ERCP) showed prominent intrahepatic biliary ducts, however the mid-to-distal common bile duct was poorly visualized below the sharp angulation (Figure 5).