Hepatic Trauma
Liver Laceration

  

• Most frequently injured abdominal organ after spleen
• Most often due to deceleration injuries
  • Often seen in association with
    • Right-sided rib fractures
    • Right-sided pneumothorax
    • Right lung contusion
    • Injuries to the right kidney or adrenal gland
• Injuries include
  • Subcapsular hematoma
  • Laceration
  • Intrahepatic hematoma
  • Contusion
• Right lobe more often injured than left
  • Injury to left lobe associated with injury to duodenum, pancreas, transverse colon
    • More often due to direct blows to the epigastrium

• High association with injuries to other organs
  • 45% with liver injuries have splenic injury
• Subcapsular hematomas
  • Lenticular configuration
  • Flattens adjacent liver
  • Often adjacent to rib fracture
  • Most occur in antero-lateral aspect of right lobe
• Liver Laceration
  • Non-enhancing region, linear or branching
  • Frequently parallel hepatic vein
  • Hypodense wedge extending to liver surface
    • Focal hepatic devascularization
  • Periportal tracking of blood
    • Frequent finding
    • Sometimes only evidence of injury
      • Due to dissecting hemorrhage
      • Bile
      • Dilated periportal lymphatics

Contrast-enhanced CT of abdomen shows linear low-attenuation defect
crossing the posterior aspect of the left lobe of the liver representing a laceration

• Hematoma
  • Higher attenuation than surrounding liver on unenhanced CT scan
  • Lower attenuation than surrounding liver on enhanced CT scan
  • Central high attenuation region containing clot
  • Hepatic vein laceration usually involves right hepatic vein near vena cava
• Contusion
  • Rare lesions
  • Low attenuation area compared to normally enhanced liver
  • Do not disrupt major portal or hepatic venous structures
• Hemoperitoneum
• Complications
  • Delayed rupture (rare)
  • Hemobilia
  • Arteriovenous fistula
  • Pseudoaneurysm
  • Biloma
  • Superinfection of hematoma
• Pitfalls
  • Adjacent rib artifacts-beam-hardening
    • Mimics laceration
      • Adjacent to ribs
      • Fade as they become farther from rib
  • Linear artifact from air-contrast level in stomach
  • Fatty liver with laceration or hematoma can be missed         
    • Clue- look at intrahepatic ducts and vessels
• Treatment
  • Conservative treatment in up to 80% in adults and almost all children
    • Monitor hemodynamic state of patient
  • Transcatheter embolization possible for bleeders
  • Healing
    • Contusions may clear in 5-7 days
    • Subcapsular hematomas may increase in size initially before clearing
    • Lacerations can heal within weeks but small, residual bilomas are common