1. Liver Trauma
Classification

2. Classification
Organ Injury Scaling
Grade Injury Description
Haematoma Subcapsular <10% surface area
I Laceration Capsular tear, < 1cm parenchymal depth
Haematoma Subcapsular, 10-50% surface area
II Haematoma Intraparenchymal, <10cm diameter
Laceration 1-3cm parenchymal depth, <10cm length
Haematoma Subcapsular, >50% surface area or expanding.
Ruptured subcapsular or parenchymal haematoma
III Intraparenchymal haematoma >10cm or expanding
Laceration >3cm parenchymal depth
Laceration Parenchymal disruption involving 25-75% of hepatic lobe or 1-3 Coinaud's segments in a single
IV lobe
Laceration Parenchymal disruption involving >75% of hepatic lobe or >3 Coinaud's segments within a single
V lobe
Vascular Juxtahepatic venous injuries ie. retrohepatic vena cava/central major hepatic veins
Vascular Hepatic Avulsion
VI

3. Classification
Organ Injury Scaling
Grade 1 hepatic injury in a 21-year-old man with a stabbing injury to the right upper
quadrant of the abdomen. Axial, contrast-enhanced computed tomography (CT) scan
demonstrates a small, crescent-shaped subcapsular and parenchymal hematoma less than 1
cm thick.
http://emedicine.medscape.com/article/370508-overview
http://emedicine.medscape.com/article/370508-overview
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.

4. Classification
Organ Injury Scaling
A 20-year-old man with systemic lupus erythematosus presented with grade 2 liver injury
after minor blunt abdominal trauma. Nonenhanced axial CT scan at the level of the hepatic
veins shows a subcapsular hematoma 3 cm thick.
http://emedicine.medscape.com/article/370508-overview
http://emedicine.medscape.com/article/370508-overview
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.

5. Classification
Organ Injury Scaling
A 20-year-old man with systemic lupus erythematosus presented with grade 2 liver injury
after minor blunt abdominal trauma (same patient as in Images above). Axial CT image
through the inferior aspect of the right lobe of the liver demonstrates multiple low-
attenuation lesions in the liver consistent with parenchymal contusion
http://emedicine.medscape.com/article/370508-overview
http://emedicine.medscape.com/article/370508-overview
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.

6. Classification
Organ Injury Scaling
Gunshot to right lobe of liver. Grade 2 injury.
Entrance wound Gunshot wound - exit
www.trauma.org
www.trauma.org
Ronald Stewart
Ronald Stewart

7. Classification
Organ Injury Scaling
Grade 3 liver injury in a 22-year-old woman after blunt abdominal trauma. Contrast-
enhanced axial CT scan through the upper abdomen shows a 4-cm-thick subcapsular
hematoma associated with parenchymal hematoma and laceration in segments 6 and 7 of
the right lobe of the liver. Free fluid is seen around the spleen and left lobe of the liver
consistent with hemoperitoneum.
http://emedicine.medscape.com/article/370508-overview
http://emedicine.medscape.com/article/370508-overview
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.

8. Classification
Organ Injury Scaling
Gunshot to right lobe of liver. Grade 3 injury.
Entrance Gunshot wound to right flank - liver injury gunshot wound
www.trauma.org
www.trauma.org
Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel
Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel

9. Classification
Organ Injury Scaling
Grade 3 injury.
Entrance Gunshot wound to right flank - liver injury gunshot wound
www.trauma.org
www.trauma.org
Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel
Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel

10. Classification
Organ Injury Scaling
Image obtained in a 35-year-old male bouncer after blunt abdominal injury. Nonenhanced
axial CT scan of the abdomen demonstrates a large subcapsular hematoma measuring more
than 10 cm. The high-attenuating areas within the lesion represent clotted blood. The
injury was classified as a grade 4 liver injury.
http://emedicine.medscape.com/article/370508-overview
http://emedicine.medscape.com/article/370508-overview
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.

11. Classification
Organ Injury Scaling
Contrast-enhanced axial CT scan in a 39-year-old man with a grade 4 liver injury shows a
large parenchymal hematoma in segments 6 and 7 of the liver with evidence of an active
bleed. Note the capsular laceration and large hemoperitoneum.
http://emedicine.medscape.com/article/370508-overview
http://emedicine.medscape.com/article/370508-overview
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.

12. Classification
Organ Injury Scaling
Multisegment infarct (segments 2, 3, 4a, and 4b) in a 40-year-old man who was in a motor
vehicle accident and underwent emergency segmental resection of the right lobe. Note the
sharply demarcated wedge-shaped area of infarction; hence, the classification as grade 4
http://emedicine.medscape.com/article/370508-overview
http://emedicine.medscape.com/article/370508-overview
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.

13. Classification
Organ Injury Scaling
Grade 4 injury.
liver laceration (blunt trauma)
www.trauma.org
www.trauma.org
Ronald Stewart
Ronald Stewart

14. Classification
Organ Injury Scaling
Grade 5 injury in a 36-year-old man who was involved in a motor vehicle accident
demonstrates global injury to the liver.
http://emedicine.medscape.com/article/370508-overview
http://emedicine.medscape.com/article/370508-overview
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.

15. Classification
Organ Injury Scaling
Grade 5 injury in a 36-year-old man who was involved in a motor vehicle accident
demonstrates global injury to the liver.
http://emedicine.medscape.com/article/370508-overview
http://emedicine.medscape.com/article/370508-overview
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.

16. Classification
Organ Injury Scaling
Grade 5 injury.
liver laceration with laceration of retrohepatic vena cava and right hepatic vein
www.trauma.org
www.trauma.org
Horacio A. Massotto, Costa Rica
Horacio A. Massotto, Costa Rica

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