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September 1951


AMA Arch Intern Med. 1951;88(3):400-405. doi:10.1001/archinte.1951.03810090131014

THE SUDDEN appearance of deeply bile-stained sputum in the course of a disease process is indeed a striking and dramatic event. The essential dynamics for such a complication seem to be the formation of a cavity either in the substance of the liver or in a walled-off subphrenic space, but in continuity with the biliary tree, and concomitantly a mechanism maintaining an increased pressure within the bile duct to allow for a continued flow of bile through the channel between the liver and the lung. These conditions are met most frequently in the parasitic diseases of the liver, and it is especially in amebic abscesses and Echinococcus cysts of the liver that bronchobiliary fistulas may be encountered. In the nonparasitic diseases of the liver the formation of a bronchobiliary fistula is quite uncommon. This rare and, as far as I have been able to ascertain, unreported complication of Hodgkin's involvement