Batalin Júnior Luís Maurício, Zandoná Mariana Conceição E Silva Seleme, Vargas Thomaz Almeida, de Oliveira Julio Cesar, Chiappetto Juliana Rocha Souza, Oliveira Cassio Vieira, Romeiro Fernando Gomes, Tanni Suzana Erico
Pulmonary Division of Internal Medicine, Botucatu School of Medicine-UNESP, São Paulo, Brazil.
Gastroenterology Division of Internal Medicine, Botucatu School of Medicine-UNESP, São Paulo, Brazil.
Front Med (Lausanne). 2022 Dec 16;9:1075745. doi: 10.3389/fmed.2022.1075745. eCollection 2022.
Biliobronchial fistula (BBF) is a rare abnormality resulting from congenital or acquired communication between the bile ducts and the bronchial tree. Patients often suffer from chronic cough, dyspnea, and bilioptysis, a pathognomonic symptom of this condition. Conservative methods such as less-invasive procedures are gradually consolidating. Nonetheless, surgery remains the primary treatment, especially in more complex cases. We present the case of a 44-year-old woman with a chronic cough, no verified periods of fever, cyclic jaundice, and episodes of yellowish sputum. She had undergone cholecystectomy in 2018 and had been hospitalized several times since for pneumonia treatment. All consequent investigations for mycobacteriosis were negative. When referred to our hospital, she had cyclic jaundice and parenchymal consolidation in the right lower lobe. Suspected bilioptysis motivated the search for a biliobronchial fistula. Magnetic resonance cholangiography (MRC) confirmed stenosis of the biliary tract and fistulous path, and sputum analysis indicated high bilirubin levels. External biliary bypass was performed as an initial conservative and definitive therapy due to the presence of liver cirrhosis. Although BBF is a rare condition when bilioptysis is suspected, a diagnostic investigation should be initiated. Our case study proposes two criteria for diagnosis: an imaging exam demonstrating the fistulous path and confirmation of bilirubin in the sputum or bronchoalveolar lavage (BAL). When diagnosed, surgical correction should be performed.
胆支气管瘘（BBF）是一种罕见的异常情况，由胆管与支气管树之间的先天性或后天性连通引起。患者常伴有慢性咳嗽、呼吸困难和咯胆，这是该病症的特征性症状。诸如微创操作等保守方法正逐渐得到巩固。尽管如此，手术仍是主要治疗手段，尤其是在更复杂的病例中。我们报告了一例44岁女性患者，她有慢性咳嗽，无确诊的发热期、周期性黄疸以及淡黄色痰液发作。她于2018年接受了胆囊切除术，此后因肺炎治疗多次住院。所有后续针对分枝杆菌病的检查均为阴性。转诊至我院时，她有周期性黄疸以及右下叶实质性实变。疑似咯胆促使对胆支气管瘘进行排查。磁共振胆管造影（MRC）证实了胆道狭窄和瘘道，痰液分析显示胆红素水平升高。由于存在肝硬化，遂进行了外引流作为初始的保守性和确定性治疗。尽管BBF是一种罕见病症，但当怀疑有咯胆时，应启动诊断性检查。我们的病例研究提出了两条诊断标准：影像学检查显示瘘道以及痰液或支气管肺泡灌洗（BAL）中胆红素得到确认。确诊后，应进行手术矫正。
