The Radiologists Role in Liver Lacerations, Journal Article Review, CT in Blunt Liver Trauma, Radiolgraphics, AAST Liver Injury Grading System

1. The Radiologists Role in Liver
Lacerations
Ryan Polselli, MD

2. Liver Laceration
Most Common: Blunt Abdomina Trauma
Liver most frequently injured
organ in blunt trauma
Mortality from 4-12%

3. CT Features:
• Lacerations
• Subcapsular/parenchymal
hematoms
• Active hemorrhage
• Jextahepatic venous injuries
• Periportal low attenuation
• Flat inferior vena cava

4. Nonsurgical management is now the
preferred strategy in hemodynamically
stable patients
Hemodynamically unstable should
undergo emergency laparotomy
Consider Interventional Embolization
for Hemodynamically Stable, Active
Bleeding

5. AAST Liver Injury Grading System
Grade Description
I Hematoma: subcapsular, <10% surface area
Laceration: capsular tear, <1 cm in parenchymal depth
II Hematoma: subcapsular, 10%–50% surface area; intraparenchymal, ︎10 cm in diameter
Laceration: 1–3 cm in parenchymal depth,<10 cm in length
III Hematoma: subcapsular, >50% surface area or expanding or ruptured subcapsular
hematoma with active bleeding; intraparenchymal, >10 cm or expanding or ruptured
Laceration: >3 cm in parenchymal depth
IV Hematoma: ruptured intraparenchymal hematoma with active bleeding
Laceration: parenchymal disruption involving 25%–75% of a hepatic lobe or one to three
Couinaud seg- ments within a single lobe
V Laceration: parenchymal disruption involving >75% of a hepatic lobe or more than three
Couinaud seg- ments within a single lobe
Vascular: juxtahepatic venous injuries (ie, retrohepatic vena cava or central major hepatic
veins)
VI Vascular: hepatic avulsion

6.
Grade I
Subcapsular hematoma, less than 10%

7. Grade II
Laceration 1 – 3 cm in depth, less than 10 cm in
length

8. Grade III
Laceration > 3 cm parenchymal depth/Intraparenchymal
hematoma

9. Grade IV
Parenchymal disruption 25-75%, 1-3 Couinad segments

10. Grade V
Laceration /disruption > 75%, more than 3 Couinaud
segments

11. Active Bleeding
Active extravasation in hematoma of right hepatic lobe through
superior segmental branch

12. Active Extravasation, Example

13. Active Extravasation, Example

14. Complications
• Delayed Hemorrhage
• Hepatic Abscess, Subphrenic Abscess
• Posttraumatic pseudoaneurysm
• Biloma, Bile peritonitis

15. Abscess and Drainage

16. Post Traumatic Pseudoaneurysm

17. Biloma and Drainage

18. CT in Blunt Liver Trauma, Woon Yoon, MD,
et. al, Radiographics, January – February,
2005, pg 87- 104