Spontaneous cholecystopleural fistula leading to biliothorax and sepsis in a cat.

JFMS Open Rep 2019 Jan-Jun;5(1):2055116919830206. Epub 2019 Feb 13.

Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.

Case Summary: A 13-year-old spayed female domestic shorthair cat presented with pleural effusion and suspected triaditis. Intake vitals and leukocytosis were consistent with a diagnosis of systemic inflammatory response syndrome. Biochemical analysis confirmed a pleural fluid-to-serum bile ratio consistent with a diagnosis of biliothorax. Abdominal ultrasound failed to identify a definitive gall bladder but noted a hypoechoic tubular structure ventral to the liver and contacting the diaphragm. Thoracic ultrasound identified a hyperechoic structure contacting the diaphragm at the same location. Thoracoabdominal CT scan identified a fluid-dense tubular structure extending from ventral to the liver, through a diaphragmatic defect and directly communicating with the pleural space, suspected to be an abnormal gall bladder. The cat was humanely euthanized, and post-mortem analysis confirmed a cholecystopleural fistula arising from the gall bladder with multifocal abscesses, mixed inflammatory hepatic infiltrates and small-cell gastrointestinal lymphoma. Culture of the abscess isolated , meeting the reported feline criteria for sepsis.

Relevance And Novel Information: To our knowledge, spontaneous cholecystopleural fistula formation leading to biliothorax and sepsis has not been previously reported in the cat. This case highlights a novel sequela of gall bladder disease in this species, and biliothorax should be a differential diagnosis for pleural effusion in cats with evidence of cholecystitis or triaditis.

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http://dx.doi.org/10.1177/2055116919830206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376519PMC
February 2019

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