Table 1

Common infection sites and pathogens of infectious complications after thermal ablation of liver tumors"

Figure 1

Ultrasound and CT findings of a liver abscess after ablation. An 83-year-old man with hepatocellular carcinoma developed recurrent fever starting on the first day after undergoing RFA. He was subsequently diagnosed with liver abscess based on imaging findings. The patient gradually recovered following treatment with catheter drainage and antibiotics, including cephalosporins and carbapenems. (A) Abdominal ultrasound performed on day 3 after ablation showed hyperechoic gas in the ablation zone of liver S5/6 (arrow); (B) A non-enhanced abdominal CT scan on day 3 after ablation showed the presence of gas in the ablation zone of the liver S5/6 (arrow), without evidence of abscess formation; (C) Abdominal ultrasound on day 20 post-ablation demonstrated an enlarged ablation zone with mixed echogenicity (arrow); (D) An enhanced abdominal CT scan in the arterial phase on day 21 after ablation identified liver abscess (arrow) with thick and rough wall. Part of the abscess wall showed enhancement, and a gas-liquid level was visible within the abscess cavity; (E) Abdominal ultrasound conducted 2 months after ablation showed hyperechoic drainage tubes, with no residual gas in the ablation zone (arrows); (F) An enhanced abdominal CT scan in the arterial phase 2 months after ablation revealed a significantly reduced ablation area in liver S5/6 (arrow). High-density drainage tubes were present within the ablation area."

Figure 2

CT findings of post-ablation cholangitis and ablation zone infection. A 55-year-old male with liver metastatic cancer developed high fever and chills on the day after RFA. He was subsequently diagnosed with cholangitis and ablated zone infection based on laboratory tests and CT examination. The patient gradually recovered after receiving catheter drainage and antibiotics therapy, including cephalosporins, carbapenems, and daptomycin. (A) An enhanced abdominal CT scan in the arterial phase on day 5 post-ablation revealed intrahepatic bile duct dilation and gas accumulation, primarily in the left liver (arrow). Gas was also visible in the ablation site in liver S3 (asterisk); (B) An enhanced abdominal CT scan in the arterial phase on day 12 post-ablation showed a reduction in intrahepatic bile duct dilation and gas within bile duct (arrow). However, the gas in the ablation site of liver S3 had increased (asterisk), and a high-density drainage tube was visible at the site (arrowhead)."

Figure 3

CT findings of peritonitis secondary to colon perforation after ablation. A 68-year-old man with hepatocellular carcinoma developed severe abdominal pain and fever on the day 2 after RFA. Imaging confirmed a diagnosis of intestinal perforation, and the patient underwent emergency surgery. However, the subsequent infection progressed to septic shock. He was transferred to the intensive care unit, where he received catheter drainage, and antifungal (i.e. carpofungine) and antibiotics (i.e. cephalosporins, carbapenems). (A) An axial abdominal enhanced CT scan in the venous phase at day 3 after ablation revealed discontinuity of the intestinal wall at hepatic flexure of colon (arrow), accompanied by surrounding fat standing (arrowhead) and free gas in the peritoneal cavity (asterisk); (B) A sagittal CT recombination image showed perforation site in the colon (arrow), located near subcapsular ablation zone of the liver S6 (arrowhead)."

Table 2

Risk factors and predictive models for infection after ablation of liver tumors"

Table 3

Guidelines or consensus recommendations for prophylactic or therapeutic use of antibiotics for liver tumor ablation"