Subphrenic abscess formation following superselective transcatheter chemoembolization for hepatocellular carcinoma

In order to achieve better results with hepatocellular carcinoma (HCC), repeated treatment using transcatheter hepatic arterial chemoembolization (TAE) with or without percutaneous ethanol injection (PEI) has been widely performed. A 73-year-old woman underwent a repeated (second) TAE two months following the primary TAE in combination with PEI. Prior to TAE, computed tomography (CT) with angiography revealed that the peripheral liver segment adjacent to the HCC was supplied exclusively via arterial flow without portal circulation. Following TAE, she developed an extrahepatic abscess with clinical and radiological evidence of ruptured HCC. A high-grade fever and right hypochondrial pain were sustained by day 10 after TAE, and CT showed a low-density mass extending into the subphrenic fluid collection. One hundred milliliters of infected fluid was drained by ultrasound-guided percutaneous aspiration from the collection. Following drainage, her clinical course was uneventful. Extrahepatic abscess formation is a rare complication of TAE, and, to our knowledge, only three cases of subphrenic abscess have been reported in the English literature. Severe ischemic necrosis of the arterial-feeding liver tissues devascularized by repeated TAE was considered to be a major contributor to this clinical condition. Early clinical suspicion combined with surgical management is mandatory in preventing serious morbidity of peritonitis accompanying repeated TAE.