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Joseph Junewick, MD FACR
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Hepatic Laceration with Active Bleeding

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 3 years ago
Updated: over 3 years ago
Tags: PEDS
Modality/Study Types: CT
Activities:
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History

Teenage with right upper quadrant pain after bicycle accident.


Case Images


Diagnosis

Hepatic Laceration with Active Bleeding

Findings

CT – Linear hepatic laceration extending to the venous confluence; minimal contrast collecting in the laceration indicates active bleeding. Note the hematoma accumulating over the bare area.

Discussion

The liver is the most common abdominal organ injured in blunt trauma; the posterior segment of the right lobe is most often involved. The liver is more vulnerable in children compared to adults because it is relatively lower in the abdomen and the ribcage is more pliable. Hemoperitoneum occurs in two-thirds of patients. Hepatic injury accounts for more than 50% of deaths related to abdominal trauma. Motor vehicle accidents are a common etiology but bicycle accidents and pedestrians struck by vehicles may be more common in certain regions.

In general, solid abdominal viscera are injured by hematoma, laceration or fracture. Injuries are often manifest by lack of enhancement; subcapsular hematoma, arteriovenous fistula, pseudoaneurysm and active extravasation can also occur. Active extravasation is defined by accumulation of attenuation equivalent to or greater than the opacificied aorta within or adjacent to the parenchyma.

Liver injuries are increasingly being managed conservatively. This rationale is based on the observation that bleeding has stopped by the time of laparotomy in most patients. Packing of the injury is less effective requiring a more radical operative approach. Mortality and morbidity correlate more with the nature of associated injuries than the grade of liver injury.

Reference

Donnelly LF. Imaging issues in CT of blunt trauma to the chest and abdomen. Petriatr Radiol (2009); Supp 3:S406-S413.



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