The liver is the second most commonly injured viscera in the blunt trauma of the abdomen. Damage to the liver occurs in 20-30% of the blunt trauma.
Right lobe injuries are four times more frequent than the left lobe.
Right lobe injuries are frequently accompanied by the injuries to the ribs and the adrenal glands.
Left lobe injuries are most frequently accompanied by the trauma of the spleen and pancreas.
Imaging Findings Of Blunt Trauma Of The Liver:
Contrast-enhanced CT (CECT):
- CECT is the best choice modality for determination of liver trauma in the hemodynamically stable patients.
- The commonest finding on CECT are the hepatic lacerations. These lacerations appear as low attenuation defects in linear or stellate patterns.
- They may extend to involve the capsule and with this volume of haemoperitoneum
- When multiple radiating lacerations are present, the exhibit “bear claw appearance”.
- Other common findings on CECT are They appear as ill-defined areas of low attenuation. The hematomas appear hyperattenuating in the acute phase, becoming hypoattenuating over time.
- They usually resolve within 6-8 weeks.
- The hematomas may be multiple or single and intraparenchymal or subcapsular.
- Subcapsular hematomas are usually located on the anterolateral aspect of the right lobe of the liver and they indent the liver margins.
- Periportal low attenuation tracking along the distribution of the portal vein is commonly seen in patients with blunt trauma of the liver. It is either due to the dissecting hemorrhage, bile or dilated periportal lymphatics because of excessive fluid resuscitation.
- Low attenuation within the Glisson’s capsule represents blood or obstructed lymphatics.
- Hypodense wedge-shaped area extending up to the liver surface due to hepatic devascularization.
- Intrahepatic/ subcapsular gas.
CT Grading (Blunt Liver Trauma)
|Grade 1||1. Capsular avulsion|
|2. Superficial lacerations < 1cm deep|
|3. Subcapsular hematoma < 1cm thick|
|4. Isolated periportal tracking|
|Grade 2||1. Parenchymal lacerations 1-3cm deep|
|2. Central/ Subcapsular hematomas 1-3cm|
|Grade 3||1. Lacerations > 3cm deep|
|2. Central/ Subcapsular hematomas >3cm|
|Grade 4||1. Massive Central/ Subcapsular hematomas >10cm|
|2. Lobar tissue destruction or devascularization|
|Grade 5||1. Biloba tissue destruction or devascularization|
- Hematomas and lacerations can be detected on ultrasound as areas of increased intraparenchymal echogenicity.
- Widespread heterogeneous liver echogenicity along with the loss of normal vascular pattern indicates global parenchymal injury.
- Haemoperitoneum can also be appreciated.
- Delayed rupture.
- AV fistula
Treatment Of Blunt Trauma Of The Liver:
- 50-80% of the adults with hepatic trauma are managed conservatively.
- Transcatheter embolization is the other treatment option.