Liver Trauma: Classification
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The document describes a standardized classification system for grading the severity of liver injuries. The classification system ranges from Grade I to Grade VI injuries, with higher grades indicating more severe injuries involving deeper lacerations, larger hematomas, and greater parenchymal disruption or vascular injuries. CT imaging is useful for evaluating the extent of injuries and assigning a grade.
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Liver Trauma: Classification
- 2. Classification Organ Injury Scaling Grade Injury Description Haematoma Subcapsular <10% surface area I Laceration Capsular tear, < 1cm parenchymal depth Haematoma Subcapsular, 10-50% surface area II Haematoma Intraparenchymal, <10cm diameter Laceration 1-3cm parenchymal depth, <10cm length Haematoma Subcapsular, >50% surface area or expanding. Ruptured subcapsular or parenchymal haematoma III Intraparenchymal haematoma >10cm or expanding Laceration >3cm parenchymal depth Laceration Parenchymal disruption involving 25-75% of hepatic lobe or 1-3 Coinaud's segments in a single IV lobe Laceration Parenchymal disruption involving >75% of hepatic lobe or >3 Coinaud's segments within a single V lobe Vascular Juxtahepatic venous injuries ie. retrohepatic vena cava/central major hepatic veins Vascular Hepatic Avulsion VI
- 3. Classification Organ Injury Scaling Grade 1 hepatic injury in a 21-year-old man with a stabbing injury to the right upper quadrant of the abdomen. Axial, contrast-enhanced computed tomography (CT) scan demonstrates a small, crescent-shaped subcapsular and parenchymal hematoma less than 1 cm thick. http://emedicine.medscape.com/article/370508-overview http://emedicine.medscape.com/article/370508-overview Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan. Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
- 4. Classification Organ Injury Scaling A 20-year-old man with systemic lupus erythematosus presented with grade 2 liver injury after minor blunt abdominal trauma. Nonenhanced axial CT scan at the level of the hepatic veins shows a subcapsular hematoma 3 cm thick. http://emedicine.medscape.com/article/370508-overview http://emedicine.medscape.com/article/370508-overview Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan. Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
- 5. Classification Organ Injury Scaling A 20-year-old man with systemic lupus erythematosus presented with grade 2 liver injury after minor blunt abdominal trauma (same patient as in Images above). Axial CT image through the inferior aspect of the right lobe of the liver demonstrates multiple low- attenuation lesions in the liver consistent with parenchymal contusion http://emedicine.medscape.com/article/370508-overview http://emedicine.medscape.com/article/370508-overview Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan. Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
- 6. Classification Organ Injury Scaling Gunshot to right lobe of liver. Grade 2 injury. Entrance wound Gunshot wound - exit www.trauma.org www.trauma.org Ronald Stewart Ronald Stewart
- 7. Classification Organ Injury Scaling Grade 3 liver injury in a 22-year-old woman after blunt abdominal trauma. Contrast- enhanced axial CT scan through the upper abdomen shows a 4-cm-thick subcapsular hematoma associated with parenchymal hematoma and laceration in segments 6 and 7 of the right lobe of the liver. Free fluid is seen around the spleen and left lobe of the liver consistent with hemoperitoneum. http://emedicine.medscape.com/article/370508-overview http://emedicine.medscape.com/article/370508-overview Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan. Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
- 8. Classification Organ Injury Scaling Gunshot to right lobe of liver. Grade 3 injury. Entrance Gunshot wound to right flank - liver injury gunshot wound www.trauma.org www.trauma.org Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel
- 9. Classification Organ Injury Scaling Grade 3 injury. Entrance Gunshot wound to right flank - liver injury gunshot wound www.trauma.org www.trauma.org Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel
- 10. Classification Organ Injury Scaling Image obtained in a 35-year-old male bouncer after blunt abdominal injury. Nonenhanced axial CT scan of the abdomen demonstrates a large subcapsular hematoma measuring more than 10 cm. The high-attenuating areas within the lesion represent clotted blood. The injury was classified as a grade 4 liver injury. http://emedicine.medscape.com/article/370508-overview http://emedicine.medscape.com/article/370508-overview Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan. Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
- 11. Classification Organ Injury Scaling Contrast-enhanced axial CT scan in a 39-year-old man with a grade 4 liver injury shows a large parenchymal hematoma in segments 6 and 7 of the liver with evidence of an active bleed. Note the capsular laceration and large hemoperitoneum. http://emedicine.medscape.com/article/370508-overview http://emedicine.medscape.com/article/370508-overview Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan. Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
- 12. Classification Organ Injury Scaling Multisegment infarct (segments 2, 3, 4a, and 4b) in a 40-year-old man who was in a motor vehicle accident and underwent emergency segmental resection of the right lobe. Note the sharply demarcated wedge-shaped area of infarction; hence, the classification as grade 4 http://emedicine.medscape.com/article/370508-overview http://emedicine.medscape.com/article/370508-overview Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan. Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
- 13. Classification Organ Injury Scaling Grade 4 injury. liver laceration (blunt trauma) www.trauma.org www.trauma.org Ronald Stewart Ronald Stewart
- 14. Classification Organ Injury Scaling Grade 5 injury in a 36-year-old man who was involved in a motor vehicle accident demonstrates global injury to the liver. http://emedicine.medscape.com/article/370508-overview http://emedicine.medscape.com/article/370508-overview Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan. Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
- 15. Classification Organ Injury Scaling Grade 5 injury in a 36-year-old man who was involved in a motor vehicle accident demonstrates global injury to the liver. http://emedicine.medscape.com/article/370508-overview http://emedicine.medscape.com/article/370508-overview Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan. Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.
- 16. Classification Organ Injury Scaling Grade 5 injury. liver laceration with laceration of retrohepatic vena cava and right hepatic vein www.trauma.org www.trauma.org Horacio A. Massotto, Costa Rica Horacio A. Massotto, Costa Rica
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