A 56-Year-Old Man Is Evaluated for Fever on Postoperative Day

A 56-year-old man is evaluated for fever on postoperative day 3.  He had undergone coronary artery bypass surgery for multivessel coronary artery disease, requiring 4 grafts.  The patient is still intubated and is receiving mechanical ventilation.  He has a history of type 2 diabetes mellitus, hypercholesterolemia, and hypertension.  Temperature is 38.9 C (102 F) , blood pressure is 130/80 mm Hg, and pulse is 90/min.  BMI is 28 kg/m².  Examination reveals coarse breath sounds bilaterally.  Heart sounds are normal.  The patient grimaces during palpation of the right upper quadrant.  Bowel sounds are decreased.  Laboratory results are as follows: Chest x-ray reveals postoperative changes but no new infiltrate.  Which of the following is the most likely diagnosis in this patient?

A) Acalculous cholecystitis
B) Acute cholangitis
C) Acute pancreatitis
D) Right lower lobe pneumonia
E) Right-sided pyelonephritis
F) Subphrenic abscess

Correct Answer:

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