“…Although often insidious in onset, rupture of the diaphragm may be a dramatic event, with a sudden tearing sensation and pain radiating to the shoulder or scapula, followed by severe dyspnea, toxicity, and shock. 8,16,17,[28][29][30][31] Hemoptysis has been described, [29][30][31] and a cough productive of "anchovy sauce" or bile-stained sputum is indicative of a hepatobronchial fistula. 6,[17][18][19]23,29,31 Most patients do not have a history of diarrhea.…”