liver trauma: classification
TRANSCRIPT
LiverLiver TraumaTrauma
ClassificationClassification
ClassificationOrgan Injury Scaling
Vascular Juxtahepatic venous injuries ie. retrohepatic vena cava/central major hepatic veins
Injury DescriptionGrade
Vascular Hepatic AvulsionVI
Laceration Parenchymal disruption involving >75% of hepatic lobe or >3 Coinaud's segments within a single
lobeV
Laceration >3cm parenchymal depth
Laceration Parenchymal disruption involving 25-75% of hepatic lobe or 1-3 Coinaud's segments in a single
lobeIV
Intraparenchymal haematoma >10cm or expanding
Ruptured subcapsular or parenchymal haematoma
Haematoma Subcapsular, >50% surface area or expanding.
III
Laceration 1-3cm parenchymal depth, <10cm length
Haematoma Intraparenchymal, <10cm diameter
Haematoma Subcapsular, 10-50% surface area
II
Laceration Capsular tear, < 1cm parenchymal depth
Haematoma Subcapsular <10% surface area
I
ClassificationOrgan Injury Scaling
Grade 1 hepatic injury in a 21-year-old man with a stabbing injury to the right upper
quadrant of the abdomen. Axial, contrast-enhanced computed tomography (CT) scan
demonstrates a small, crescent-shaped subcapsular and parenchymal hematoma less than 1
cm thick.
Grade 1 hepatic injury in a 21-year-old man with a stabbing injury to the right upper
quadrant of the abdomen. Axial, contrast-enhanced computed tomography (CT) scan
demonstrates a small, crescent-shaped subcapsular and parenchymal hematoma less than 1
cm thick.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
http://emedicine.medscape.com/article/370508-overviewhttp://emedicine.medscape.com/article/370508-overview
ClassificationOrgan Injury Scaling
A 20-year-old man with systemic lupus erythematosus presented with grade 2 liver injury
after minor blunt abdominal trauma. Nonenhanced axial CT scan at the level of the hepatic
veins shows a subcapsular hematoma 3 cm thick.
A 20-year-old man with systemic lupus erythematosus presented with grade 2 liver injury
after minor blunt abdominal trauma. Nonenhanced axial CT scan at the level of the hepatic
veins shows a subcapsular hematoma 3 cm thick.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
http://emedicine.medscape.com/article/370508-overviewhttp://emedicine.medscape.com/article/370508-overview
ClassificationOrgan Injury Scaling
A 20-year-old man with systemic lupus erythematosus presented with grade 2 liver injury
after minor blunt abdominal trauma (same patient as in Images above). Axial CT image
through the inferior aspect of the right lobe of the liver demonstrates multiple low-
attenuation lesions in the liver consistent with parenchymal contusion
A 20-year-old man with systemic lupus erythematosus presented with grade 2 liver injury
after minor blunt abdominal trauma (same patient as in Images above). Axial CT image
through the inferior aspect of the right lobe of the liver demonstrates multiple low-
attenuation lesions in the liver consistent with parenchymal contusion
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
http://emedicine.medscape.com/article/370508-overviewhttp://emedicine.medscape.com/article/370508-overview
ClassificationOrgan Injury Scaling
Ronald StewartRonald Stewart
www.trauma.orgwww.trauma.org
Gunshot to right lobe of liver. Grade 2 injury.
Entrance wound Gunshot wound - exit
ClassificationOrgan Injury Scaling
Grade 3 liver injury in a 22-year-old woman after blunt abdominal trauma. Contrast-
enhanced axial CT scan through the upper abdomen shows a 4-cm-thick subcapsular
hematoma associated with parenchymal hematoma and laceration in segments 6 and 7 of
the right lobe of the liver. Free fluid is seen around the spleen and left lobe of the liver
consistent with hemoperitoneum.
Grade 3 liver injury in a 22-year-old woman after blunt abdominal trauma. Contrast-
enhanced axial CT scan through the upper abdomen shows a 4-cm-thick subcapsular
hematoma associated with parenchymal hematoma and laceration in segments 6 and 7 of
the right lobe of the liver. Free fluid is seen around the spleen and left lobe of the liver
consistent with hemoperitoneum.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
http://emedicine.medscape.com/article/370508-overviewhttp://emedicine.medscape.com/article/370508-overview
ClassificationOrgan Injury Scaling
Arieh Eitan, Western Galilee Hospital, Nahariyya, IsraelArieh Eitan, Western Galilee Hospital, Nahariyya, Israel
www.trauma.orgwww.trauma.org
Entrance Gunshot wound to right flank - liver injury gunshot wound
Gunshot to right lobe of liver. Grade 3 injury.
ClassificationOrgan Injury Scaling
Arieh Eitan, Western Galilee Hospital, Nahariyya, IsraelArieh Eitan, Western Galilee Hospital, Nahariyya, Israel
www.trauma.orgwww.trauma.org
Entrance Gunshot wound to right flank - liver injury gunshot wound
Grade 3 injury.
ClassificationOrgan Injury Scaling
Image obtained in a 35-year-old male bouncer after blunt abdominal injury. 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.
Image obtained in a 35-year-old male bouncer after blunt abdominal injury. 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.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
http://emedicine.medscape.com/article/370508-overviewhttp://emedicine.medscape.com/article/370508-overview
ClassificationOrgan Injury Scaling
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.
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.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
http://emedicine.medscape.com/article/370508-overviewhttp://emedicine.medscape.com/article/370508-overview
ClassificationOrgan Injury Scaling
Multisegment infarct (segments 2, 3, 4a, and 4b) in a 40-year-old man who was in a motor
vehicle accident and underwent emergency segmental resection of the right lobe. Note the
sharply demarcated wedge-shaped area of infarction; hence, the classification as grade 4
Multisegment infarct (segments 2, 3, 4a, and 4b) in a 40-year-old man who was in a motor
vehicle accident and underwent emergency segmental resection of the right lobe. Note the
sharply demarcated wedge-shaped area of infarction; hence, the classification as grade 4
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
http://emedicine.medscape.com/article/370508-overviewhttp://emedicine.medscape.com/article/370508-overview
ClassificationOrgan Injury Scaling
liver laceration (blunt trauma)liver laceration (blunt trauma)
Ronald StewartRonald Stewart
www.trauma.orgwww.trauma.org
Grade 4 injury.
ClassificationOrgan Injury Scaling
Grade 5 injury in a 36-year-old man who was involved in a motor vehicle accident
demonstrates global injury to the liver.
Grade 5 injury in a 36-year-old man who was involved in a motor vehicle accident
demonstrates global injury to the liver.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
http://emedicine.medscape.com/article/370508-overviewhttp://emedicine.medscape.com/article/370508-overview
ClassificationOrgan Injury Scaling
Grade 5 injury in a 36-year-old man who was involved in a motor vehicle accident
demonstrates global injury to the liver.
Grade 5 injury in a 36-year-old man who was involved in a motor vehicle accident
demonstrates global injury to the liver.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
http://emedicine.medscape.com/article/370508-overviewhttp://emedicine.medscape.com/article/370508-overview
ClassificationOrgan Injury Scaling
liver laceration with laceration of retrohepatic vena cava and right hepatic veinliver laceration with laceration of retrohepatic vena cava and right hepatic vein
Horacio A. Massotto, Costa RicaHoracio A. Massotto, Costa Rica
www.trauma.orgwww.trauma.org
Grade 5 injury.
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