A 43-year-old male with acute right upper quadrant pain and skin rash.

A 43-year-old male presented with acute right upper quadrant pain, nausea, and itchy skin rash for two hours. Physical examination revealed abdominal tenderness and itchy abdominal skin lesions that are compatible with urticaria. The patient’s blood pressure was 95/55 mmHg, pulse rate was 122 beats/minute, body temperature was 37.1 C degrees, and partial oxygen saturation was 96% in the room air. He had no history of recent trauma or chronic disease. Laboratory test results were within normal limits except for increased white blood cell count (14.79 K/uL, reference range; 4-10 K/uL). Abdominal ultrasound (US) was performed, and the US revealed abdominal free fluid and a thin-walled lobulated cystic lesion in the liver dome. For further evaluation, contrastenhanced abdominal computed tomography (CT) was obtained. CT showed a thin-walled cystic lesion with lobulated contours in the liver, pericystic fat stranding, perihepatic free fluid, and right pleural effusion (Figure 1).