27th June 2023

A 28-year-old female presents to hospital with a 3-day history of sharp right upper quadrant abdominal pain.

A 28-year-old female presents to hospital with a 3-day history of sharp right upper quadrant abdominal pain. The pain is worse on inspiration and on coughing. There is no history of fevers, cough, or weight loss. She was born in the UK and has not travelled anywhere in the past year. She does not have any past medical or surgical history and rarely seeks medical attention. Her only regular medication is the combined oral contraceptive pill. She drinks eight units of alcohol a week and is a non-smoker. Examination reveals a tender right upper quadrant but no other abnormalities.

Blood tests reveal:

• Urine dipstick: Negative leucocytes and nitrites, negative blood, negative protein.
• CXR: Normal
• CTPA: No PE
• Abdominal ultrasound: Normal
• CT abdomen pelvis with contrast: Subtle enhancement of the liver capsule

On further questioning, she has had three male sexual partners in the past six months with whom she has not used any barrier contraception. Her last sexual health screening was two years ago. She denies any symptoms of dysuria or abnormal vaginal discharge but has experienced some lower abdominal pain in recent weeks.

Given her presentation, which of the following tests is likely to reveal the underlying cause of her symptoms?

Select the SINGLE most appropriate option from the list below. Select ONE option only.