Eight cholangio-thoracic fistula patients were seen from 1981 to 1987 in our hospital. The clinical features of the cases were classified into four types, i.e. bronchobiliary fistula (BBF, 3 cases), bronchopleurobiliary fistula (BPBF, 2 cases), pleurobiliary fistula (PBF, 2 cases) and pericardiobiliary fistula (PCBF, 1 case). In addition to a history of cholangitis or cholelithiasis and continuous or intermittent secondary biliary tract infection, the principle manifestations of BBF included: acute, subacute or chronic biliary empyema; biliary pneumonia or biliary lung abscess; and biliptysis. The empyema perforating into trachea, bronchus, pericardium and large vessels in the thoracic cavity may result in serious consequences. Asphyxiation, pericardial tamponade and abrupt massive intrathoracic hemorrhage may also be fatal. It is often difficult to locate the fistula by bronchoscopy, however the bile found in the respiratory tract may suggest BBF. Surgical management of BBF and PCBF are discussed.