CECT Imaging of Liver Lacerations
1. Imaging Protocol
Contrast-Enhanced CT (CECT) is the gold standard for evaluating stable trauma patients with suspected hepatic injury. A multi-phase study (arterial and portal venous) is ideal for identifying active extravasation.
2. Radiographic Findings
- Lacerations: Appear as low-attenuation (dark) linear or branching clefts within the liver parenchyma.
- Hematomas:
- Intraparenchymal: Focal, rounded low-attenuation areas.
- Subcapsular: Crescentic (lens-shaped) fluid collections compressing the underlying liver parenchyma.
- Active Extravasation: High-density (bright) contrast material pooling outside the vessels, appearing as a “jet” or “blush” on arterial phase images. This signifies ongoing hemorrhage.
3. AAST Liver Injury Scale (Simplified)
| Grade | Key Findings |
|---|---|
| I | Hematoma <10% surface area; laceration <1cm deep. |
| II | Hematoma 10-50% surface area; laceration 1-3cm deep. |
| III | Hematoma >50% surface area or ruptured; laceration >3cm deep. |
| IV | Parenchymal disruption involving 25-75% of the hepatic lobe. |
| V | Parenchymal disruption >75% or juxtahepatic venous injuries. |
4. Management Pearls
- Non-Operative Management (NOM): The standard of care for hemodynamically stable patients, regardless of injury grade, provided there is no evidence of peritonitis or other indications for surgery.
- Angioembolization: Indicated if CECT demonstrates persistent active contrast extravasation (a “blush”) in a stable patient.