A Senile Man with Cystic Lesion of Liver

Question: An 83-yearold man presented with fever, biliary pain, and eosinophilia for 2 weeks. During admission in our hospital, the vital signs included: temperature 38.5C, pulse 90 beats/ min, respiratory rate 20 breaths/min, and blood pressure 140/85 mm Hg. On physical examination, the patient had tenderness in right upperquadrant and mild jaundice. Laboratory investigation revealed the following results: white blood cell count, 16.3 K/ mm3; eosinophil count, 5%; polymorphonuclear neutrophil count, 78%; hemoglobin, 9.7 g/dL; erythrocyte sedimentation rate, 95; aspartate aminotransferase, 96 IU/L; alanine aminotransferase, 156 IU/L; alkaline phosphatase, 562IU/L; total bilirubin, 2.1 mg/dL; and conjugated bilirubin, 1.1 mg/dL. Abdominal CT (Figure A, B), endoscopic ultrasonography (Figure C), and endoscopic retrograde cholangiopancreatography (Figure D) were performed (endoscopic ultrasonography film as Supplementary Figure 1). What is the diagnosis?by Ahmad Hormati in Shahid-beheshti-hospital, Qom, Iran).