A 38-year-old woman, originally from Kashmir, India, presented for evaluation of right upper-quadrant abdominal pain. The results of her laboratory tests were remarkable for moderate eosinophilia (absolute eosinophil count 1760/μL), hyperbilirubinemia (total bilirubin 4.5 mg/dL), and elevated alkaline phosphatase (229 U/L). A CT scan of the abdomen and ultrasonography of the liver revealed a multiseptated cyst within the right hepatic lobe, measuring 10 cm × 9 cm × 9 cm (Figs. 1A and B). Additionally, dynamic US footage (not pictured) showed dense mobile echoes (“snowflake sign”), representing shifting of hydatid sand. Serologic testing detected an IgG antibody to Echinococcus species.
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