Bile leaking into the abdomen can reach the pleural space resulting in a bilious pleural effusion.
Patient selection: pleural effusion
Preceding events:
(1) hepatic abscess or other infection (amebiasis, echinococcosis, etc)
(2) subphrenic or subhepatic abscess
(3) biliary peritonitis
(4) iatrogenic (cholecystectomy, hepatectomy, liver biopsy, percutaneous biliary drainage, etc)
Diagnostic features:
(1) discoloration of the pleural fluid
(2) ratio of total bilirubin in the pleural fluid to that in the serum > 1
(3) presence of glycocholic acid or other bile salts in the pleural fluid
