CASE PRESENTATION: A 59 year-old male presented to our medical center with a two-week history of progressive abdominal discomfort, jaundice and unintentional weight loss. The patient was diagnosed with pancreatic adenocarcinoma and a percutaneous drain was placed to alleviate his biliary obstruction. Two weeks into the hospital course, the patient developed new right pleuritic chest pain. A computed tomography of the thorax and abdomen was performed, which demonstrated a right loculated pleural effusion (Figure 1). Bedside ultrasound revealed a complex fluid collection with multiple septations. Pleural fluid analysis exhibited an empyematous bilothorax with a green, cloudy color. The pH was 7.02, total protein ratio 0.71, LDH 1170 IU/L and pleural fluid/serum total bilirubin ratio 1.17 (8.8: 7.5 mg/dL). A hepatobiliary scan did not reveal a biliopleural fistula. The patient was treated with tube thoracostomy for drainage of the loculated pleural effusion along with broad spectrum antibiotics for pleural infection.