COMPLEX PLEURAL EFFUSION ASSOCIATED WITH A SUBPHRENIC GALLSTONE PHLEGMON FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

A 90-year-old man presented with a large right-sided complex pleural e ffusion 4 months after a laparoscopic cholecystectomy. An initial thor acic CT scan confirmed the presence of the effusion, and the results o f thoracentesis on three separate occasions were consistent with an ex udative process. Another CT scan of the chest with thin-section cuts t hrough the diaphragm along with an abdominal ultrasound revealed a ret rohepatic subdiaphragmatic gallstone collection that eroded into the r ight hemidiaphragm. Thoracoscopic evacuation of the phlegmon, removal of the spilled gallstones, and repair of the diaphragm resulted in res olution of the effusion.