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Unusual Presentation of Left‐Sided Bilothorax Following Spleen Laceration: A Case Without Biliary Tree Injury

Year: 2026

Type: article

Abstract: A 46-year-old pedestrian sustained blunt injury to abdomen when he was struck from behind by a motorcycle, causing him to fall flat onto the roadway. Ultrasound abdomen showed splenic injury and hemoperitoneum. Chest x-ray showed left mild pleural effusion. He was managed conservatively by multiple blood transfusions for anemia and referred to our center after 3 weeks. A triphasic CT scan of abdomen revealed a splenic laceration with multiple pseudoaneurysms, moderate hemoperitoneum, and trace bilateral pleural effusions. No biliary tree injury or fistula was identified. On fifth postoperative day after splenectomy, he developed progressive breathlessness and ultrasound showed increased effusion on left side. Around 500 mL of green pleural fluid was aspirated, which was exudative by Light's criteria and cultures were sterile. Pleural fluid to serum bilirubin ratio was more than one, confirming diagnosis of bilothorax. The most likely mechanism for development of bilothorax is due to resorption of hemoperitoneum and splenic hematoma across left diaphragm into pleural space and heme degradation.

Source: Clinical Case Reports

DOI: 10.1002/ccr3.73841

Authors: Thanuja Reddipilli, Raghava Rao Gandra, Vishwanath Gella, Deekshitha Ithepalli

Institution: Asian Institute of Gastroenterology

Language: English

Topic: Abdominal Trauma and Injuries

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,820