A 50-year-old Indian woman with diabetes and hypertension presented with right upper abdominal discomfort, loss of appetite and low grade fever. She had no history of jaundice. Examination revealed hepatomegaly and tenderness in the right hypochondrium. An abdominal sonography revealed an 11 × 7.5 × 11.2 cm, predominantly anechoic, thick-walled lesion arising from the inferior surface of the liver with a few low-level internal echoes and a homogenous echogenic area in the superolateral portion of the lesion. The gallbladder could not be visualized separately and the other abdominal viscera were normal. Her liver function tests were normal and serological tests for amoebiasis and hydatid disease were negative. Her chest X-ray was normal. A diagnosis of liver abscess was made and aspiration of the lesion revealed turbid fluid. However, the lesion did not resolve with repeated aspirations and antibiotics. A contrast enhanced computerized tomography (CECT) scan revealed a well-defined, lobulated cystic lesion with a solid component in the superior part of the lesion. Figure and Figure show the proximity of the lesion to the colon and duodenum. The lesion was interpreted as an infected non-parasitic cyst and evacuation and deroofing of the cyst were performed. Histopathological examination of the excised cyst wall revealed a biliary cystadenoma with nuclear atypia. Subsequently, a radical excision of the lesion with a partial excision of the liver was performed. The final histological diagnosis was biliary cystadenocarcinoma infiltrating liver.