A middle-aged man with an unremarkable medical history presented with fever for 2 weeks. He had no recent travel history. He had epigastric tenderness but was haemodynamically stable.

Chest X-ray (CXR) showed a right-sided subdiaphragmatic air-fluid level (figure 1). Blood tests showed neutrophilia (14.6×109/L) and a cholangiohepatitic picture (bilirubin 77 umol/L; alkaline phosphatase 917 U/L; gamma-glutamyltransferase 743 U/L; alanine aminotransferase 302 U/L; aspartate aminotransferase 246 U/L). CT revealed a 16×11×9 cm lobulated gas-containing abscess involving the left lobe and segment …