History of colonic mass resection, recurrent chest infection. Chest tube placement for recurrent effusion, chest tube oozing stool.
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After instilling contrast via rectal enema, it leaks through the defect in the inferior aspect of the posteromedial left parietal pleura to collect in the left costophrenic recess of the pleural cavity.
The key to this diagnosis is to follow the course of the contrast material which, after having been injected through the rectum, crosses into the pleural cavity. That, coupled with relevant clinical history and the chest tube oozing stool cinch the diagnosis of a colopleural fistula.