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.

Select Relevant Investigations
Liver profile + Pancreatic Enzymes


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)
Ultrasound Abdomen


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.
Contrast CT Abdomen


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.
Imaging Guided Aspiration


The aspirate has an ‘anchovy sauce’ appearance. Samples are sent for serological and microbiological analysis.

Select Relevant Management
IV Cefotaxime
IV Metronidazole
Nil Orally