Cholecystopleural fistula with cholelithiasis presenting as a right pleural effusion.

At autopsy, multiple gallstones were recovered from the right pleural space of an elderly patient who presented with a massive right pleural effusion and septic shock. The mechanisms of gallstone migration and fistula formation between the gallbladder and right pleural space are described. Despite atypical presentations, gallbladder disease remains an important differential consideration of right pleural effusion in the elderly.