A 76-year-old white woman with ovarian adenocarcinoma developed massiv
e biliptysis following an unexpected respiratory arrest. The possibili
ty of active right upper quadrant disease had not been entertained unt
il she developed this complication of a biliobronchial fistula. Becaus
e this sign had not previously been observed by any of us, it led to a
comprehensive review of the topic of biliobronchial fistula.