A 26-year-old woman presents with worsening right upper quadrant pain for 3 weeks. She also developed jaundice since 5 days ago. On further questioning, she mentions that she has lost 2 kg of weight over the last fortnight. Her medical and surgical histories are unremarkable, and she is not on any medications. There is no history of recent travel. She drinks socially and has never smoked.
The ultrasound reveals a multiseptated cystic mass within the left lobe of the liver, with a wheel-like appearance and a maximum diameter of ~16cm. The extrahepatic biliary tree is dilated, with the common bile duct showing a diameter of 8mm. No enlarged lymph nodes are seen.
ALT: 31 U/L (8-40) AST: 21 U/L (8-40) ALP: 350 U/L (30-110) Total bilirubin: 3 mg/dL (0.1-1.1) Albumin: 4.2 g/dL (3.5 - 5.9)
The Enzyme-linked Immunoelectrotransfer Blot (EITB) assay is positive for anti-echinococcal antibodies against E. granulosus.
Microscopy of the aspirate reveals multiple protoscolices.