Persistent Pyrexia after Portal Vein Embolisation: Diagnostic Contribution of ¹⁸ F FDG PET/CT

Portal vein embolisation (PVE) is a commonly performed intervention to induce hypertrophy of the future liver remnant (FLR) before major hepatectomy. It is generally well tolerated, with self-limited fever in a few patients. Infectious complications following PVE are rare but clinically significant and adversely affect surgical outcomes. We report a 27-year-old male with gallbladder malignancy with biliary obstruction who underwent percutaneous transhepatic biliary drainage (PTBD) followed by right portal and hepatic vein embolisation. One week after the procedure, he developed persistent fever, leucocytosis, and pain, with inconclusive blood and bile cultures. ¹⁸ F FDG PET/CT performed for evaluation of pyrexia of unknown origin demonstrated linear branching FDG uptake along embolized vascular territories, suggestive of hepatic infection. Subsequent bile culture from the segment VI drain grew Pseudomonas aeruginosa. The patient showed clinical improvement following antibiotic therapy. This case highlights the potential utility of ¹⁸ F FDG PET/CT in detecting post-PVE hepatic infection and facilitating timely management.