HEPATIC TRAUMA - IMAGING FINDINGS

• Hepatic trauma
   
   
   
  • CT: Contrast-enhanced
    • Laceration: Linear or stellate hypodensity
    • Parenchymal/subcapsular hematoma: Lenticular lesion, varying density
      • Unclotted blood is acutely 35-45 HU, hypodense to liver
      • Clotted blood is 60-90 HU, hyperdense to unclotted blood and normal liver
    • Active extravasation or pseudoaneurysm: 85-350 HU, isodense to enhanced vessels
    • Hemoperitoneum: Perihepatic and peritoneal recess blood / hypodense fluid
    • Periportal tracking: Linear, focal, or diffuse periportal hypodensities, may be due to blood or bile versus dilated periportal lymphatics or overhydration 
    • AAST Classification of Hepatic Injury:

Grade	Laceration	Hematoma
I-III	Same as Splenic Injury	Same as Splenic Injury
IV	>10 cm deep Lobar maceration or devascularization	Subcapsular or central, >10 cm diameter
V	Bilobar tissue maceration or devascularization

• Angiography: Active extravasation, pseudoaneurysm, or fistula (arteriovenous, arteriobiliary or portobiliary)
• MR: Varied signal intensity depending on degree/age of hemorrhage and infarct
• Ultrasound: Anechoic lentiform or curvilinear fluid collection (subcapsular hematoma), rounded echogenic or hypoechoic foci (intraparenchymal hematoma), rounded anechoic loculated collection with well-defined margins close to bile ducts (biloma), irregular defects (lacerations)
• SOURCE: AUNT MINNIE DOT COM