IMAGING IN LIVER INJURY

LIVER TRAUMA

Largest solid abdominal organ. Fixed

position. Partially protected by ribs.

Second most common injured, But

most common cause of death after
abdominal trauma (35-45%).
 CAUSES

Blunt (nonpenetrating) abdominal injuries

usually result from motor vehicle accidents, fights,
falls from heights, and sports accidents.

Penetrating abdominal injuries usually result

from stabbings and gunshots.
 TYPES OF INJURY

Subscapular hematome
or intrahepatic
hematome

Traumatic
hemobillier
laceration

Gall bladder
injury contusion

Bile duct vascular

injury disruption
ANATOMY OF LIVER
 MECHANISM OF INJURY

Direct impact

Acceleration deceleration forces

Shearing forces
GRADING OF LIVER INJURIES
CT-BASED INJURY GRADING SYSTEM
 CT LIVER OF BLUNT LIVER TRAUMA
Laceration

lacerations are the most

common type of
parenchymal liver injury
appear as irregular linear or
branching low-attenuation
areas at contrast-enhanced
CT
Lacerations can be classified
as :
1. superficial (3 cm in depth)
2. deep (>3 cm).
 Hematoma
Subcapsular hematoma
appears as an elliptic
collection of low-attenuation
blood between the liver
capsule and enhancing liver
parenchyma at contrast-
enhanced CT
Subcapsular hematomas can
be differentiated from free
intraperitoneal blood in the
perihepatic space in that the
former cause indentation or
flattening of the underlying
liver margin, whereas the
latter does not
 Parenchymal
hematomas or
contusions are
characterized by focal
low-attenuation areas
with poorly defined
irregular margins in
the liver parenchyma
at contrast-enhanced
CT
 Acute hematomas
are typically
hyperattenuating
(4060 HU) relative
to normal liver
parenchyma at
unenhanced CT
 Acute Hemorrhagic :
typically identified at early
phase contrast-enhanced
CT as focal high-
attenuation areas that
represent a collection of
extravasated contrast
material
ranged from 91 to 274 HU
(mean, 155 HU)
clotted blood ranged from 28
to 82 HU (mean, 54 HU).
 Active hemorrhage
after blunt liver
trauma can
manifest as
extravasation of
contrast material
ALGORITM OF LIVER INJURY
 MINOR
Grade I-II NON OPERATIF
MANAGEMENT (94% OF
NOM)

SEVERE
Grade III-V REQUIRE OPERATIVE
TREATMENT
 INDICATION OF OPERATION
Indication of operation

Blunt injury Penetrating injury

Penetration
Hemodinamic
beneath
instability
peritoneum

Devitalized Instability
parenchyma hemodinamic

Sepsis/byloma eviceration