Learning Radiology - Liver, Laceration, Hepatic

Liver Laceration

Most frequently injured abdominal organ after spleen
Most often due to deceleration injuries

Often seen in association with

Right-sided rib fractures
Right-sided pneumothorax
Right lung contusion
Injuries to the right kidney or adrenal gland

Injuries include

Subcapsular hematoma
Laceration
Intrahepatic hematoma
Contusion

Right lobe more often injured than left

Injury to left lobe associated with injury to duodenum, pancreas, transverse colon

More often due to direct blows to the epigastrium

High association with injuries to other organs

45% with liver injuries have splenic injury

Subcapsular hematomas

Lenticular configuration
Flattens adjacent liver
Often adjacent to rib fracture
Most occur in antero-lateral aspect of right lobe

Liver Laceration

Non-enhancing region, linear or branching
Frequently parallel hepatic vein
Hypodense wedge extending to liver surface

Focal hepatic devascularization

Periportal tracking of blood

Frequent finding
Sometimes only evidence of injury

Due to dissecting hemorrhage
Bile
Dilated periportal lymphatics

Hematoma

Higher attenuation than surrounding liver on unenhanced CT scan
Lower attenuation than surrounding liver on enhanced CT scan
Central high attenuation region containing clot
Hepatic vein laceration usually involves right hepatic vein near vena cava

Contusion

Rare lesions
Low attenuation area compared to normally enhanced liver
Do not disrupt major portal or hepatic venous structures

Hemoperitoneum
Complications

Delayed rupture (rare)
Hemobilia
Arteriovenous fistula
Pseudoaneurysm
Biloma
Superinfection of hematoma

Pitfalls

Adjacent rib artifacts-beam-hardening

Mimics laceration

Adjacent to ribs
Fade as they become farther from rib

Linear artifact from air-contrast level in stomach
Fatty liver with laceration or hematoma can be missed

Clue- look at intrahepatic ducts and vessels

Treatment

Conservative treatment in up to 80% in adults and almost all children

Monitor hemodynamic state of patient

Transcatheter embolization possible for bleeders
Healing

Contusions may clear in 5-7 days
Subcapsular hematomas may increase in size initially before clearing
Lacerations can heal within weeks but small, residual bilomas are common

Liver laceration with extravasation. An enhanced axial CT scan of the upper abdomen shows a large laceration through the right lobe of the liver (blue arrow), blood in the peritoneal cavity (black arrows) and active extravasation of the intravenous contrast (red arrow). The stomach is labeled "S."
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Liver Laceration. Contrast-enhanced CT of abdomen shows linear
low-attenuation defect crossing the posterior aspect of the right lobe
of the liver representing a laceration.

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