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Brocho-biliary fistula: A rare complication after ruptured liver abscess in a 3½ year old child.

Kumar P, Mehta P, Ismail J, Agarwala S, Jana M, Lodha R, Kabra SK - Lung India (2015 Sep-Oct)

Bottom Line: An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified.Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract.On follow-up child was asymptomatic and doing well.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Bronchobiliary fistula (BBF) is a rare condition, defined by the presence of abnormal communication between biliary tract and bronchial tree. We describe a 3½-year-old child who developed BBF after rupture of liver abscess. She underwent exploratory laparotomy and peritoneal wash for ruptured liver abscess. Seven months later she presented with fever and cough with yellow-colored expectoration (bilioptysis). An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified. Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract. On follow-up child was asymptomatic and doing well.

No MeSH data available.


Related in: MedlinePlus

(a) Chest radiograph PA view shows right-sided pleural effusion and a large air-fluid level at right lower hemithorax (block arrow) (b) Axial CECT image of liver reveals reduced volume of the right lobe; associated with diffuse hyperdense attenuation of the entire lobe. Note absent opacification of the right branch of portal vein whereas left branch is well visualized (arrow) (c) Coronal reformatted image of CECT of chest and abdomen reveals extensive right lower lobe consolidation with areas of cavitation (d) MRCP shows a hyperintense track containing fluid could be traced (block arrow); extending from the liver (right hepatic duct) to the lower lobe bronchi, suggesting a broncho-biliary fistula
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Figure 1: (a) Chest radiograph PA view shows right-sided pleural effusion and a large air-fluid level at right lower hemithorax (block arrow) (b) Axial CECT image of liver reveals reduced volume of the right lobe; associated with diffuse hyperdense attenuation of the entire lobe. Note absent opacification of the right branch of portal vein whereas left branch is well visualized (arrow) (c) Coronal reformatted image of CECT of chest and abdomen reveals extensive right lower lobe consolidation with areas of cavitation (d) MRCP shows a hyperintense track containing fluid could be traced (block arrow); extending from the liver (right hepatic duct) to the lower lobe bronchi, suggesting a broncho-biliary fistula

Mentions: Investigations revealed hemoglobin of 10.4 gm/dL, total leukocyte count of 11,700/mm3 with 69% neutrophils, 30% lymphocytes, 1% eosinophils and platelet count of 4.1 × 105 per microliter. Peripheral blood smear examination was normal. Mantoux test was negative. Gastric aspirate for acid-fast bacilli (AFB) was negative on two occasions. The sputum smears and cultures were negative for bacteria and AFB. Human immunodeficiency virus (HIV) serology was also negative. Other immunodeficiency work-up including CD4/CD8 counts, nitroblue tetrazolium tests (NBT) test for chronic granulomatous disease and immunoglobulin profile were within normal limits. Liver function tests were within normal limits. Chest X-ray showed homogenous opacity of right lower zone with blunting of right costophrenic angle [Figure 1a]. Ultrasound abdomen was done which showed altered architecture of right lobe of liver with minimal right pleural effusion. Doppler imaging showed attenuation of right branch of portal vein.


Brocho-biliary fistula: A rare complication after ruptured liver abscess in a 3½ year old child.

Kumar P, Mehta P, Ismail J, Agarwala S, Jana M, Lodha R, Kabra SK - Lung India (2015 Sep-Oct)

(a) Chest radiograph PA view shows right-sided pleural effusion and a large air-fluid level at right lower hemithorax (block arrow) (b) Axial CECT image of liver reveals reduced volume of the right lobe; associated with diffuse hyperdense attenuation of the entire lobe. Note absent opacification of the right branch of portal vein whereas left branch is well visualized (arrow) (c) Coronal reformatted image of CECT of chest and abdomen reveals extensive right lower lobe consolidation with areas of cavitation (d) MRCP shows a hyperintense track containing fluid could be traced (block arrow); extending from the liver (right hepatic duct) to the lower lobe bronchi, suggesting a broncho-biliary fistula
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4587006&req=5

Figure 1: (a) Chest radiograph PA view shows right-sided pleural effusion and a large air-fluid level at right lower hemithorax (block arrow) (b) Axial CECT image of liver reveals reduced volume of the right lobe; associated with diffuse hyperdense attenuation of the entire lobe. Note absent opacification of the right branch of portal vein whereas left branch is well visualized (arrow) (c) Coronal reformatted image of CECT of chest and abdomen reveals extensive right lower lobe consolidation with areas of cavitation (d) MRCP shows a hyperintense track containing fluid could be traced (block arrow); extending from the liver (right hepatic duct) to the lower lobe bronchi, suggesting a broncho-biliary fistula
Mentions: Investigations revealed hemoglobin of 10.4 gm/dL, total leukocyte count of 11,700/mm3 with 69% neutrophils, 30% lymphocytes, 1% eosinophils and platelet count of 4.1 × 105 per microliter. Peripheral blood smear examination was normal. Mantoux test was negative. Gastric aspirate for acid-fast bacilli (AFB) was negative on two occasions. The sputum smears and cultures were negative for bacteria and AFB. Human immunodeficiency virus (HIV) serology was also negative. Other immunodeficiency work-up including CD4/CD8 counts, nitroblue tetrazolium tests (NBT) test for chronic granulomatous disease and immunoglobulin profile were within normal limits. Liver function tests were within normal limits. Chest X-ray showed homogenous opacity of right lower zone with blunting of right costophrenic angle [Figure 1a]. Ultrasound abdomen was done which showed altered architecture of right lobe of liver with minimal right pleural effusion. Doppler imaging showed attenuation of right branch of portal vein.

Bottom Line: An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified.Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract.On follow-up child was asymptomatic and doing well.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Bronchobiliary fistula (BBF) is a rare condition, defined by the presence of abnormal communication between biliary tract and bronchial tree. We describe a 3½-year-old child who developed BBF after rupture of liver abscess. She underwent exploratory laparotomy and peritoneal wash for ruptured liver abscess. Seven months later she presented with fever and cough with yellow-colored expectoration (bilioptysis). An abnormal communication between right branch of the hepatic duct and a branch of right main bronchus was identified. Child underwent right lateral thoracotomy and right lower lobectomy with surgical excision of sinus tract. On follow-up child was asymptomatic and doing well.

No MeSH data available.


Related in: MedlinePlus