Investigations:
Admission labs were pertinent for a hemoglobin of 5.6 g/dL, a WBC of 12.4 K/microL, and a lactic acid of 2.5 mmol/L. Negative labs included HIV, hepatitis panel, Neisseria gonorrhoeae , RPR, EBV IgM, IgG and antigen, Plasmodium falciparum  antigen and thin and thick blood smear.  Chest CT demonstrated a hepatic abscess to pericardial communication (Figure 1). Triple phase abdominal CT scan showed multiple liver abscesses with communication into the right cardiophrenic space (Figure 2). Hepatic abscess aspirate cultures grew Fusobacterium nucleatum . A transthoracic echocardiogram (TTE) revealed a large pericardial effusion, and serial TTEs demonstrated expansion of this effusion leading to tamponade physiology with diastolic right ventricular collapse and tricuspid valve E inflow respiratory variation >60% (Figures 3, 4). Pericardiocentesis was performed with 300 mL of fluid removed out of which no organisms were isolated. Repeat CT abdomen and pelvis showed persistent multiloculated fluid collections (Figure 5). MRI pelvis confirmed a right adnexal multiloculated mass concerning for tubo-ovarian abscess (Figure 6), ultimately requiring percutaneous nephrostomy due to mass effect and subsequent hydronephrosis.