A 38 year old woman presents with a history of dull right upper quadrant pain for five days. On the morning of presentation this pain increased in severity and became generalized. She denies fever, chills, or vomiting. She has no history of jaundice. On physical exam she is pale with a pulse of 116 and a blood pressure of 100/50. There is a mass felt in the right upper quadrant which seems to be arising from the liver. There is generalized abdominal tenderness. There is no splenomegaly. She is not icteric.