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Biloptysis and sputum dipstick test result. (A) Brownish sputum (in sputum container). Discharge from percutaneous transhepatic biliary drainage tube (bile bag). (B) Comparison between two urinalysis strips. An unreacted strip (to the left) and a pathological (to the right, from the patient) strip. Pathological strip reacted with bilirubin in sputum and produced a characteristic color (arrow, bilirubin [+++]).
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He remained well for 4 months, after which he developed brownish sputum (Fig. 1), a cough, and fever. The sputum was positive for bilirubin according to a urine dipstick test (Fig. 1).
Bronchobiliary fistula. (A) Coronal computed tomography scan reveals a consolidation in the right lower lobe with subdiaphragmatic abscess (arrows). (B) Bile-colored secretion in right lower lobar bronchus. (C) Aspirated bronchial secretion. (D, E) Tubogram reveals dilatated bile duct and a fistulous communication with the right bronchial tree (arrows).
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Flexible bronchoscopy showed a bile-colored secretion in the right lower lobar bronchus (Fig. 2). A tubogram was performed and revealed a dilated bile duct and a fistulous communication with the right bronchial tree (Fig. 2); thus, confirming the diagnosis of BBF.
After diagnosed with bronchobiliary fistula: arrow in (A), the lipiodol embolization is performed (B,C).
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Lipiodol embolization was then performed through a PTBD tube (Fig. 3).