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Medical Mystery — Abdominal Pain
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     A 40-year-old, previously healthy man presented with a four-day history of pain in the left upper quadrant of the abdomen, accompanied by fatigue, fever, sweating, and sore throat. Physical examination revealed exudative pharyngitis, an enlarged lymph node in the left-sided posterior cervical region, and mild tenderness in the left upper quadrant with no hepatosplenomegaly. A computed tomographic scan of the patient's abdomen is shown here. What is the diagnosis?

    Editor's note: We invite our readers to submit their answers at www.nejm.org/mystery. We will publish the diagnosis in the Correspondence section of the September 29, 2005, issue and e-mail it to everyone who submits an answer. All answers must be received by August 18, 2005.

    Karen M. Kim, M.D.

    Tufts University School of Medicine

    Boston, MA 02111

    Richard I. Kopelman, M.D.

    Tufts–New England Medical Center

    Boston, MA 02111