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Figure it out fridays 

#59

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A 58-year-old male presented to the ER with complaints of fever, nausea, vomiting, and pain in the right upper quadrant. 

3 months previously he was diagnosed with acute cholecystitis confirmed by abdominal ultrasound which showed cholelithiasis without any evidence of gall bladder changes. He was treated conservatively and discharged home in a stable condition with elective laparoscopic cholecystectomy 6 weeks later that was uneventful

No past medical or surgical history 

On examination, he was in acute distress, his pulse was 116/bpm, he was febrile (101 F) and his respiratory rate was 25/min. 

On abdominal examination: mild epigastric tenderness without any signs of peritoneal irritation, and Murphy’s sign was negative. 

Labs:

WBC: 35,000/mm3, hemoglobin: 12.9g/dl, platelet count: 110,000/mm3. 

LFT:- ALT: 155 IU/L, AST: 125 IU/L, ALP: 310 IU/L, LDH: 350 I/U, and normal bilirubin levels. Renal function: normal, hepatitis serology:  negative.

USS abdomen: well-circumscribed non-homogenous fluid collection in the right lobe of the liver without any changes in the gall bladder. 

CT scan of the abdomen was done to confirm the lesion (images)

 

What is your diagnosis based on the history and radiological findings?

A. Liver abscess

B. Biloma

C. Liver cyst

D. HCC

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