A 40 year old man presents with jaundice and dull abdominal pain for 1 week, and a high grade, intermittent fever with chills and rigors for 2 weeks. The pain was initially periumbilical, but became generalized over time; it was unaltered by meals or posture. He is a heavy drinker. There is no history of IV drug abuse or sexual promiscuity. He arrived home 3 weeks ago, after spending a month in Kenya. His FBC is significant for WBC/DC 14,600/mm3 with 85% neutrophils, Hb 11.9 g/dL, and platelets 130,000/mm3.
AST: 62 U/L (<35) ALT: 58 U/L (<35) ALP: 682 U/L (40-125) GGT: 50 U/L (5-55) S. Bilirubin: 2.1 mg/dL (<1) INR: 1.15 (0.9-1.1) Albumin: 3.4 g/dL (3.4- 5.4) Serum Amylase: 146 U/L (40-140)
The liver is enlarged, with a 20.5 cm span. There is a 11.1 x 9.6 cm cyst of mixed echogenicity, with irregular margins & a thickened wall in the postero-superior aspect of the right lobe. A small subhepatic collection is also seen. No other abnormalities are noted.
CT imaging confirms the presence of a cystic lesion with thickened walls measuring 11.2 x 9.7 cm in the postero-superior aspect of the right lobe.
The aspirate has an ‘anchovy sauce’ appearance. Samples are sent for serological and microbiological analysis.