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Is This an Infected Liver Cyst?

      Question: A 79-year-old man with polycystic liver disease was referred to our hospital for right hypochondrial pain and fever. His medical history indicated that he received percutaneous aspiration and ethanol injection for polycystic liver disease 5 years previously. His family history was unremarkable. Physical examination revealed epigastric tenderness without rebound pain. Laboratory data indicated leukocytosis with a white blood cell count of 13,300/μL (neutrophils, 80%; lymphocytes, 16%; monocytes, 2%; eosinophils, 2%), and an elevated C-reactive protein of 12.8 mg/dL. The other biochemical test results were as follows: aspartate aminotransferase, 25 IU/L; alanine aminotransferase, 23IU/L; total bilirubin level, 1.2 mg/dL; and lactate dehydrogenase, 190 IU/L. Chest radiographs revealed no abnormality. Emergency contrast-enhanced computed tomography (CT) revealed multiple liver cysts. The diameter of the largest cyst was 25 cm and was located in the right lobe. A second large lesion in the left lobe had higher density on CT than the other cysts and had a slightly thickened wall (Figure A, B).
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