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Thoracobiliary fistulas (bronchobiliary and pleurobiliary) are rare complications of thoracoabdominal trauma. Owing to
their rarity, there is little consensus on the optimal management .The diagnostic suspicion however must be considered
and it’s important the correct selection of diagnostic imaging techniques.
Biliptysis is the pathognomonic physical finding of bronchobiliary fistulas. Demonstration of high bilirubin levels in the
pleural effusion is diagnostic for a pleuro-biliary fistula.
The optimal treatment of bronchobiliary fistulas is operative, in order to prevent their dramatic consequences. For pleurobiliary
fistulas, a light aggressive conservative approach is an appealing option in the beginning. Newer endoscopic techniques
increase the non-operative approach.