Publication:

Complex pleural complications in metastatic cholangiocarcinoma: a case report highlighting massive subcutaneous emphysema, bronchopleural fistula and palliative hemostatic radiotherapy

Cholangiocarcinoma (CCA) is an aggressive biliary malignancy with poor prognosis, typically diagnosed at advanced stages. Common metastatic sites include liver, lymph nodes, and peritoneum, while pleural involvement remains rare and poorly described. Such atypical presentations may lead to significant morbidity and complex clinical scenarios requiring invasive management. This study reports a rare case of metastatic CCA with pleural involvement complicated by severe pleuropulmonary manifestations, including infection, bronchopleural fistula, (BPF) and massive subcutaneous emphysema occurring in the setting of malignant pleural disease and persistent pleural air leak requiring one-way valve drainage, as well as life-threatening intrapleural bleeding successfully managed with palliative hemostatic radiotherapy. This case highlights the diagnostic and therapeutic challenges associated with uncommon metastatic patterns in CCA.