Spontaneous Hepatobronchial Communications Preceding Pyothorax in a Patient with Suspected Liver Abscess: A case report

This is an account of a patient in whom biliary tract infection had been suspected, and in whom diagnostic percutaneous transhepatic cholangiography disclosed hepatobronchial fistulae. He subsequently developed purulent pleuritis. It seems that pyogenic changes in the liver parenchyma altered the intrahepatic lymphatics in an early phase of the disease, and subsequent formation of cephalad lymphatic channels through the so-called “bare area” of the diaphragm explained the pleuropulmonary complication that is common in liver abscess.