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The patient was evaluated for a bronchobiliary fistula with computed tomography (CT) scan of the chest and abdomen (Figures 1, 2), and a dimethyl iminodiacetic acid (HIDA) scan (Figure 3).
The patient was diagnosed with bronchobiliary fistula, and she went to operation.
The common causes of bronchobiliary fistula are rupture of a hydatid cyst or erosion of an abscess through the diaphragm.
Physicians should have a high index of suspicion of bronchobiliary fistula in patients presenting after hepatic intervention with cough and yellow-green sputum that is not ameliorated with antibiotics.
Rarer presentations of right-sided CDH include superior vena cava syndrome and congenital bronchobiliary fistula.