NOTE: Enjoy this interesting case based question of the the holidays!   The answer will be posted next week!

A 47-year-old male farmer from China with a history of chronic Hepatitis B (not on treatment) and biliary stricture in the past presented with complaints of fever, sharp epigastric abdominal pain and nausea/ bilious vomiting that began 48-72 hours prior to admission. Liver function tests were mildly elevated. He was here visiting his daughter from China and was in the U.S for the past 2 weeks. Of note, he had lost about 10 lbs. in the last 5-6 months; this was non-purposeful in nature. ERCP was performed given his symptoms and lab findings, with placement of a stent in the biliary tree due to the presence of another stricture that was found; however, CT scan of the abdomen/pelvis with contrast performed just prior to the ERCP revealed the findings below.

What do you think these findings best represent?

1. Hepatocellular carcinoma
2. Entamoeba liver cyst
3. Echinococcus liver cyst
4. Tuberculosis
5. Q-fever infection
6. Fasciola hepatica infection