Hepatopleural Fistula Secondary to a Persistent Liver Abscess: A Case Report

Hepatopleural fistula (HPF) is an abnormal communication between the pleural cavity and the hepatobiliary system; it is uncommon and carries relevant morbidity. Reported etiologies include thoracoabdominal trauma, liver abscess of different causes, biliary stenosis or obstruction, postsurgical iatrogenesis, and even congenital anomalies. We present the case of a 37-year-old woman with six months of right upper-quadrant pain and intermittent fever. Contrast-enhanced computed tomography (CT) showed a liver abscess; percutaneous drainage achieved initial improvement. One month later, she presented with exertional dyspnoea, productive cough, and fever. Studies demonstrated a loculated right pleural effusion and a persistent abscess, with imaging signs of hepatopleural communication suggestive of HPF. A pleural tube was placed with an initial 2,000 mL output, followed by posterolateral thoracotomy with decortication and fistula closure, plus anterior and posterior chest drainage. The course was favorable with resolution of infection and discharge with imaging follow-up. This case underscores the need for high clinical suspicion in unresolved liver abscesses progressing to empyema and supports timely surgical management in the absence of biliary obstruction, complemented by targeted antibiotics.