An Article By

Dr. Ahmed Esawy

MBBS M.Sc MD

Of all patients with blunt trauma to the

abdomen, about 15% to 20% involves the

liver. Isolated injuries to the liver occur in

less than 50% of blunt trauma victims.

LIVER TRAUMA

CT CRITERIA FOR STAGING

LIVER TRAUMA BASED ON

THE AAST (AMERICAN

ASSOCIATION OF

SURGEONS IN TRAUMA)

LIVER INJURY SCALE

INCLUDE THE FOLLOWING:

Grade 1: Subcapsular hematoma less than 1 cm

in maximal thickness. Superficial parenchymal

laceration less than 1 cm deep.

Grade 2: Parenchymal laceration 1-3 cm deep

and parenchymal/subcapsular hematomas 1-3 cm

thick

Grade 3: Parenchymal laceration more than 3 cm

deep and parenchymal or subcapsular hematoma

more than 3 cm in diameter

Grade 4: Parenchymal/subcapsular hematoma more

than 10 cm in diameter, lobar destruction, or

devascularization

Grade 5: Global destruction or devascularization

of the liver

Grade 6 : Hepatic avulsion

The intravenously and oral

enhanced CT examination

of the abdomen

demonstrates the

presence of a linear area

of low attenuation within

the posterior segment of

the right lobe of the liver

(arrow heads). Fluid is

noted within Morrison's

pouch as well.

LIVER LACERATION

Interventional radiology for liver injury

concerns in embolization for active liver

bleeding

The dual blood supply of the liver makes

postembolization infarction less likely.

Penetrating injuries of the liver from stab

and gunshot wounds have been managed

successfully with transcatheter

embolization using similar criteria as those

in blunt hepatic injuries.

Contrast-enhanced axial CT scan in a grade 3 liver injury in a

21-year-old woman. A deep laceration extends from the

periphery of the liver to the hilum, damaging the adjacent

gallbladder .

Although CT remains the examination

of choice in the evaluation of liver

trauma, the procedure of choice to

evaluate bile leaks is 99mTc IDA

scanning

CT and ultrasonography can both help

detect intra-abdominal fluid, but

differentiation between loculated

ascitic fluid and hematoma, abscess,

and biloma may not be always

possible.

LARGE HEPATIC HAEMATOMA

SMALL PARENCHYMAL INJURY OF

THE LIVER

Contrast enhanced spiral CT: wide hematoma in the right lobe of the

liver with deep laceration extending to the IVC

Contrast enhanced spiral CT: another deep laceration is visible extending from

the hematoma to the inner hepatic border. Moreover the right adrenal is

disrupted and replaced by an extensive hemorrhage

Subcapsular haematoma

Subcapsular haematoma

Subcapsular haematoma

A)Grade 3 liver injury in a young male patient who fell off a bike. Transaxial CT

scan shows 5-cm-thick subcapsular and parenchymal hematoma containing

both high-density clotted and low-density unclotted blood

B)Grade 3 liver injury in a young male patient who fell off a bike (same patient

as in Image 12). CT scan was obtained 2 months after the initial injury. The

subscapular and intraparenchymal hematoma has organized, showing

homogeneous low attenuation.

A)Abdominal sonogram in a 35-year-old male bouncer after blunt

abdominal injury shows a crescent-shaped hyperechoic

collection along the right lateral aspect of the liver consistent with

subcapsular hematoma

C)Image in a 35-year-old male bouncer after blunt abdominal injury

(same patient as in Images 14-15). Diagram of the CT scan in Image

B)Image obtained in a 35-year-old male bouncer after blunt abdominal injury (same

patient as in Image 14). Nonenhanced axial CT scan of the abdomen demonstrates a

large subcapsular hematoma measuring more than 10 cm. The high-attenuating areas

within the lesion represent clotted blood. The injury was classified as a grade 4 liver injury

B)Diagram of the CT scan in Image 18 in a 39-year-old man with a grade 4 liver

injury shows a large parenchymal hematoma in segments 6 and 7 of the liver

with evidence of an active bleed.

A)Contrast-enhanced axial CT scan in a 39-year-old man with a grade 4 liver

injury shows a large parenchymal hematoma in segments 6 and 7 of the liver

with evidence of an active bleed. Note the capsular laceration and large

hemoperitoneum.

Axial CT scan in a 40-year-old woman with a grade 4 injury demonstrates a

right lobar parenchymal contusion.

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