ABSTRACT
Bronchobiliary fistula (BBF) is a tract between the biliary system and bronchial tree
with the presence of bile in the bronchus and the sputum. They are rare but serious
complications. In most cases, they are caused by hepatic or subphrenic abscesses,
resulting from different conditions. Pulmonary symptoms dominate the clinical picture,
and the main manifestations are chronic irritant cough, production of greenish sputum,
bronchopneumonia, and dyspnea. The diagnosis of BBF can be confirmed by imaging procedures
such as biliary scintigraphy with hepatobiliary iminodiacetic acid, percutaneous transhepatic
cholangiography, or endoscopic retrograde cholangiopancreatography. Bronchoscopy can
demonstrate the presence of bile in the bronchial tree and may delineate the site
of fistula. The treatment strategy for patients with BBF and biliary tract obstruction
is the reestablishment of bile drainage, which allows the fistula to heal by reducing
intrabiliary pressure. We present two cases of biliary-bronchial fistula, one related
to hepatic abscess and the other due to percutaneous transhepatic biliary drainage
for common bile duct obstruction secondary to inoperable hilar cholangiocarcinoma.
KEYWORDS
Bilioptysis
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bronchobiliary fistula
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hepatobiliary iminodiacetic acid scan
