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Ryan Polselli

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The Radiologists Role in Liver Lacerations, Journal Article Review, CT in Blunt Liver Trauma, Radiolgraphics, AAST Liver Injury Grading System

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Ryan Polselli

  1. 1. The Radiologists Role in Liver Lacerations Ryan Polselli, MD
  2. 2. Liver Laceration 
 Most Common: Blunt Abdomina Trauma Liver most frequently injured organ in blunt trauma Mortality from 4-12%
  3. 3. CT Features: • Lacerations • Subcapsular/parenchymal hematoms • Active hemorrhage • Jextahepatic venous injuries • Periportal low attenuation • Flat inferior vena cava
  4. 4. Nonsurgical management is now the preferred strategy in hemodynamically stable patients
 
 Hemodynamically unstable should undergo emergency laparotomy
 
 Consider Interventional Embolization for Hemodynamically Stable, Active Bleeding
  5. 5. AAST Liver Injury Grading System Grade Description I Hematoma: subcapsular, <10% surface area Laceration: capsular tear, <1 cm in parenchymal depth II Hematoma: subcapsular, 10%–50% surface area; intraparenchymal, ︎10 cm in diameter Laceration: 1–3 cm in parenchymal depth,<10 cm in length III Hematoma: subcapsular, >50% surface area or expanding or ruptured subcapsular hematoma with active bleeding; intraparenchymal, >10 cm or expanding or ruptured Laceration: >3 cm in parenchymal depth IV Hematoma: ruptured intraparenchymal hematoma with active bleeding Laceration: parenchymal disruption involving 25%–75% of a hepatic lobe or one to three Couinaud seg- ments within a single lobe V Laceration: parenchymal disruption involving >75% of a hepatic lobe or more than three Couinaud seg- ments within a single lobe Vascular: juxtahepatic venous injuries (ie, retrohepatic vena cava or central major hepatic veins) VI Vascular: hepatic avulsion
  6. 6. 
 
 Grade I
 
 Subcapsular hematoma, less than 10%
  7. 7. Grade II Laceration 1 – 3 cm in depth, less than 10 cm in length
  8. 8. Grade III Laceration > 3 cm parenchymal depth/Intraparenchymal hematoma
  9. 9. Grade IV Parenchymal disruption 25-75%, 1-3 Couinad segments
  10. 10. Grade V Laceration /disruption > 75%, more than 3 Couinaud segments
  11. 11. Active Bleeding Active extravasation in hematoma of right hepatic lobe through superior segmental branch
  12. 12. Active Extravasation, Example
  13. 13. Active Extravasation, Example
  14. 14. Complications • Delayed Hemorrhage • Hepatic Abscess, Subphrenic Abscess • Posttraumatic pseudoaneurysm • Biloma, Bile peritonitis
  15. 15. Abscess and Drainage
  16. 16. Post Traumatic Pseudoaneurysm
  17. 17. Biloma and Drainage
  18. 18. CT in Blunt Liver Trauma, Woon Yoon, MD, et. al, Radiographics, January – February, 2005, pg 87- 104
  • DiniKurniaUtari1

    May. 11, 2019

The Radiologists Role in Liver Lacerations, Journal Article Review, CT in Blunt Liver Trauma, Radiolgraphics, AAST Liver Injury Grading System

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