MSFinals-6143

MSFinals-6143

A 55-year-old sheep farmer who recently arrived in the UK from Iran presents with increasing right upper quadrant (RUQ) pain of two week’s duration. She also complains of tiredness and of being generally unwell for several months. She has not experienced a change in her bowel habit, weight loss, or night sweats.

Upon examination, her temperature is 37.8ºC, heart rate 80/min, blood pressure 135/90 mmHg, respiratory rate 18/min. She is mildly jaundiced with RUQ pain and the liver edge is palpable 3 cm below the costal margin.

Blood tests revealed raised eosinophils and her LFTs were as follows:
– Bilirubin 30 µmol/l
– ALP 190 u/l
– ALT 36 u/l

An ultrasound scan of her liver demonstrated a 7 cm cystic lesion. The scan was technically challenging but there appeared to be daughter cysts present.

What is the recommended next investigation to carry out?