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It is a rare complication of biliary and liver diseases, and can occur spontaneously in some hepatobiliary infections or, more frequently, secondary to some type of surgical manipulation or invasive percutaneous procedure.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> There are also forms of cholethorax without fistulas or macroscopic defects allowing bile flow from abdomen to pleural space.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report a case of cholethorax in a 92-year-old patient with a history of multiple biliary colic and recurrent calculous cholecystitis and cholangitis, which eventually required a laparoscopic cholecystectomy, performed 2 years earlier. A year after cholecystectomy, the patient reported a new episode of cholangitis secondary to a residual choledocholithiasis, which required a papillotomy performed with endoscopic retrograde cholangiopancreatography (ERCP). The patient was admitted to our center with symptoms of fever and pain in the right flank. The blood test data showed infection (neutrophilic leukocytosis, increased C-reactive protein), cholestasis (elevated bilirubin) and liver damage (elevated liver enzymes). Abdominal ultrasound showed aerobilia (without bile duct dilatation) and a hypoechoic lesion in segment 8 of the liver followed by a small right pleural effusion. A CT scan of chest and abdomen confirmed an abscess in the posterior segments of the right hepatic lobe communicated with the pleural space through the bare area of the liver and right hemidiaphragm. Given these findings it was decided to perform percutaneous drainage under radiological control of the loculated right pleural effusion, obtaining greenish fluid material. The pleural fluid analysis showed inflammatory cells and a high level of total bilirubin and higher than the level of serum bilirubin. The patient experienced a rapid clinical and radiological improvement after pleural drainage and administration of intravenous antibiotic treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Most of cholethorax have been described in the past associated with hepatic hydatid cysts, but today most cases are secondary to procedural percutaneous complications.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> These procedures include percutaneous transhepatic biliary drainage, percutaneous cholecystectomies, or radiofrequency of focal liver lesions. In our case, we believe that repeated clinical history of complicated biliary symptomatology, and especially cholangitis secondary to a residual choledocholithiasis (requiring sphincterotomy with ERCP) one year after cholecystectomy, predisposed the patient to an ascending cholangitis and development of a liver abscess. The appearance of deferred liver abscesses has been described as a late complication in patients with cholangitis or after cholecystectomy or ERCP.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> In our case, this liver abscess was communicated with the pleural space through the bare area of the liver (an area at the posterosuperior surface of the liver without peritoneal cover) and a small defect in the right hemidiaphragm, verified by imaging techniques. Small posterior diaphragmatic defects discovered in adults can be congenital or, more commonly, acquired. The latter are usually secondary to high energy blunt trauma or excessive strain of the diaphragm during procedures such as laparoscopy or in patients with tense ascites.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">To our knowledge, there are no cases reported in the scientific literature of spontaneous biliopleural communication (without percutaneous pleural biopsy) as a late complication of recurrent cholangitis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gorospe Sarasúa L, Ayala-Carbonero AM, Fernández-Méndez MÁ, González-García A. Biliotórax: una complicación tardía poco frecuente de la colangitis recurrente. 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