Current Thoracic Surgery

Bronchobiliary fistula (BBF) is a rare condition characterized by an abnormal communication between the biliary tract and the bronchial tree. In developing countries, it most commonly occurs as a complication of hepatic hydatid cysts or amebic liver abscesses, whereas in developed countries, it is more frequently associated with trauma or previous biliary surgery. Bilioptysis, defined as the expectoration of bilestained sputum, is a pathognomonic symptom observed in most patients. The diagnostic and therapeutic management of BBF requires a multidisciplinary and patient-specific approach, beginning with noninvasive or minimally invasive procedures and sometimes requiring major surgical intervention. This case is remarkable because, despite clinical findings suggestive of BBF, preoperative imaging failed to demonstrate the fistulous tract. Moreover, the intraoperative discovery of gallstones within a destructed lung parenchyma makes this case exceptionally rare.