Real-time Fluoroscopic Fusion Imaging Guidance Using Angio-computed Tomography for Percutaneous Drainage of a Difficult-to-access Liver Abscess: A Case Report

A liver abscess developed in the left subphrenic space in a 42-year-old man with liver metastases from gastric cancer. Because ultrasound did not detect the abscess, percutaneous drainage was planned with real-time fluoroscopic fusion imaging guidance using angio-computed tomography. A computed tomography scan was obtained, and the abscess cavity was manually delineated using dedicated software. On the basis of pre- and intra-procedural computed tomography images, the transhepatic epigastric approach was selected. The delineated area was overlaid onto fluoroscopy, and a needle was advanced toward the overlaid target. A drainage catheter was inserted using the Seldinger technique. No adverse events occurred, and the inflammatory markers improved after drainage. This case reveals the potential utility of real-time fluoroscopic fusion imaging guidance using angio-computed tomography for abscess drainage in anatomically challenging locations.