A 45 year old female presents with 48 hour history of right upper quadrant pain, dyspnea, non-productive cough, fever with chills and rigor. The pain radiates to right shoulder tip. She has history of perforated duodenal ulcer repair 3 weeks ago. Temperature 39.3degC. O/E there is acute tenderness over right hypochondrium. CXR shows right sided pleural effusion. Diagnosis