THORACOBILIARY FISTULA

Thoracobiliary communications in the form of either pleurobiliary or b ronchobiliary fistulas are reported complications of many diseases. A strong suspicion in the appropriate clinical setting is necessary to r ecognize this problem. Bilioptysis is the sine qua non of a bronchobil iary fistula. Diagnostic imaging studies are useful to identify the co mmunication and to delineate its location. Although surgery is the opt imal intervention, percutaneous drainage and intravenous antimicrobial therapy may offer the best therapeutic option in patients with metast atic cancer and limited physiologic reserve. We report a unique case o f bronchobiliary fistula complicating a uterine leiomyosarcoma with he patic metastases. Long-term palliation was achieved with percutaneous drainage and appropriate fluid and electrolyte replacement therapy.