Learning Radiology xray montage
 
 
 
 
 

Liver Trauma
Hepatic 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

liver laceration

Liver Laceration. Contrast-enhanced CT of abdomen shows linear
low-attenuation defect crossing the posterior aspect of the right 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