Abstract： Objective:To study the clinical value of multi-detector spiral CT manifestations and 3D imaging of biliary tract in the diagnosis and treatment of biliary liver abscess among fishermen in coastal areas.Methods:The clinical data，CT images，and treatment outcomes of 80 local fishermen with biliary liver abscess admitted to Beihai People's Hospital of Guangxi between January 2018 and December 2021 were retrospectively analyzed.Results:Biliary liver abscess was mostly seen in males（51 cases，63.8%），and among middle-aged and elderly patients（46 cases，57.5%）. Single-lesion cases were common（68 cases，85.0%），and the incidence of the lesion involving the right hepatic lobe was the highest（52 cases，65.0%）. There were many underlying diseases，mainly diabetes（17 cases，21.2%），followed by gout（12 cases，15.0%），chronic hepatitis B（10 cases，12.5%），hypertension（6 cases，7.5%），etc. CT manifestations were characterized by ring signs，cluster signs，and gas signs in pus cavities. Some patients had transient enhancement of the liver parenchyma around the lesion during the early arterial phase. The 3D imaging of bile ducts showed dilation of adjacent intrahepatic bile ducts，accompanied by gallstones or infection of the biliary tract system. The patients were given standardized antibiotic treatment，ultrasound-guided puncture and aspiration of pus，catheterization and drainage of abscess，relief of biliary duct obstruction，and surgical resection. Compared with the CT images before treatment，the lesions disappeared or were reduced to varying degrees in all cases，according to CT reviewing within 2 to 3 weeks of treatment.Conclusion:A comprehensive analysis of clinical features，multi-detector spiral CT manifestations，and 3D reconstruction of CT images can clarify the relationship between biliary tract-related diseases and liver abscess，thereby improving the diagnostic accuracy of biliary liver abscess and facilitating the selection of clinical treatment.