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Hepatic Trauma

Leyla Azmoun, MD
Piran Aliabadi, MD
B Leonard Holman, MD

December 11, 1995

Presentation

A 27-year-old woman was brought to the emergency room after being hit by a car. She was placed in a cervical collar at the scene. She was alert and oriented and denied any head trauma or loss of consciousness. On physical exam, her BP was 100/70 mmHg and her pulse was 100. Her abdomen was mildly distended and was diffusely tender. Her neurological exam was normal. Initial blood tests revealed hematocrit of 32%.

Imaging Findings

Abdominal and pelvic CT

Radiographs of the chest, pelvis and lateral cervical spine (in the collar) are unremarkable.

CT of abdomen and pelvis demonstrate linear low-density lacerations of the dome (arrow) and right lobe of the liver (arrow), extending to the hepatic capsule. There is a large amount of hemoperitoneum anterolateral to the liver (arrow) and spleen (arrow), along the pericolic gutters (arrows), and in the pelvis (arrow). A hematocrit level (layering of blood) is seen in the pelvis (arrow).

The patient remained hemodynamically stable and was treated conservatively.

Diagnosis

Hepatic trauma

Discussion

Hepatic injuries occur in 3 to 10% of patients sustaining blunt abdominal trauma. Mortality from blunt hepatic trauma is 8 to 25% and is often related to uncontrolled hemorrhage or associated visceral injuries. Contrast-enhanced abdominal CT is the imaging modality of choice in evaluating hemodynamically stable patients with suspected hepatic injury. Abdominal CT accurately defines the morphology and extent of the hepatic trauma, identifies associated visceral injuries and depicts the amount of accompanying hemoperitoneum. CT is also helpful in evaluating interval healing or post-operative complications.

Hepatic parenchymal injuries can be categorized by CT as contusions, subcapsular and parenchymal hematomas, linear or stellate lacerations, and hepatic fractures. On contrast-enhanced CT, areas of parenchymal injury are often lower in density than normal liver. Lacerations are the most common form of hepatic injury identified on CT, while contusions and subcapsular hematomas are the least common. Despite CT evidence for extensive hepatic parenchymal injury, many hemodynamically stable patients can be managed nonoperatively. CT findings which indicate increased morbidity and the need for more aggressive management include laceration of a major hepatic vein, complex perihilar injuries, progression of a hepatic injury on follow-up studies or persistent hemoperitoneum within one week.

Sonography has a limited role in initial diagnostic evaluation of hepatic trauma, but it may be useful in follow-up of patients who are treated conservatively. Ultrasound can also be used in diagnosing post-traumatic complications such as hepatic or perihepatic abscesses or bilomas.

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