Time for another Radiology Round by our Associate Editor Tess Litchman!

We have an older-aged woman found to have gastric and duodenal ulcers requiring multiple abdominal surgeries and transhepatic biliary drainage presenting with respiratory distress

She underwent pleural fluid drainage with the following pleural fluid studies

She ultimately had a right chest tube placed with 1.6 liters of green pleural fluid was drained

Given concern for a bilothorax, a pleural and serum bilirubin test were added. Her pleural bilirubin level was 17.2 and her serum bilirubin level was 0.5. Her chest tube was maintained, IV antibiotics were started and multi-disciplinary meetings occurred to determine next steps.