Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging

Romano, Luigia; Giovine, S; Guidi, Guido De; Tortora, Giovanni; Cinque, Teresa; Romano, Stefania

doi:10.1016/j.ejrad.2003.11.015

Cited by 54 publications

(26 citation statements)

References 29 publications

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“…This group compared the radiological findings with the clinical outcome in patients managed conservatively as well as those patients undergoing surgery and concluded that even major hepatic trauma, as defined by grade 4 on the CT scheme, could be managed without surgery in haemodynamically stable patients. These findings have been supported by recent reports [11,21,23], which have concluded that CT scanning is an essential part of an accurate classification.…”

Section: Classification Of Liver Traumasupporting

confidence: 84%

“…There is no doubt that the introduction and refinement of CT scanning has had the greatest impact on the classification and subsequent management of liver trauma [20]. CT scanning is able to identify subcapsular or central haematomas, contusions, peri‐portal tracking of fluid, complex lacerations and fragmentation or avulsions of the hepatic pedicle [21] (Figure 1). Despite the AAST classification incorporating extensive preoperative assessment data derived from the CT examination, the perceived benefit of this investigation, especially in blunt trauma, has led to the development of additional CT‐based classification schemes.…”

Section: Classification Of Liver Traumamentioning

confidence: 99%

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Classification of liver and pancreatic trauma

Oniscu

Parks

Garden

2006

HPB

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The liver is the most frequently injured intra-abdominal organ and associated injury to other organs increases the risk of complications and death. This has highlighted the critical need for an accurate classification system as a basis for the clinical decision-making process. Several classification systems have been proposed in an attempt to incorporate the aetiology, anatomy and extent of injury and correlate it with subsequent clinical management and outcome. The widely accepted Organ Injury Scale is based on anatomical criteria that quantify the disruption of the liver parenchyma and defines six groups which may influence management strategies and relate to outcome. The less common pancreatic injury remains a major source of morbidity and mortality due to the likelihood of associated solid or hollow-organ injuries. The implication of a delay in diagnosis and management emphasizes the need for an accurate classification system. The Organ Injury Scale is widely used for pancreas trauma and recognizes the importance of progressive parenchymal injury and in particular ductal injury. Advances in imaging techniques have led to the development of newer radiological classification systems; however, validation of their accuracy remains to be proven. An accurate classification of liver and pancreatic trauma is fundamental for the development of treatment protocols in which clinical decisions are based on the severity of injury.

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Section: Classification Of Liver Traumasupporting

confidence: 84%

Section: Classification Of Liver Traumamentioning

confidence: 99%

Classification of liver and pancreatic trauma

Oniscu

Parks

Garden

2006

HPB

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“…Correctly identifying injuries on CT in a timely manner is of utmost importance as it can significantly affect the early management a patient receives and thus their outcome [3,4]. Although on-the-job training provides invaluable learning experiences, reviewing cases in a safe environment within tutorials and through self-directed learning, is also necessary.…”

Section: Discussionmentioning

confidence: 99%

Trauma radiology: The need for a teaching trauma case series

Hm¹,

Hacking²

2017

Trauma Emerg Care

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Introduction: Computed Tomography (CT) is the most widely utilised imaging modality in the adult trauma setting. Accurate interpretation is vital for the appropriate management to be instigated. Given that many radiology training programs do not expose trainees to significant volumes of major trauma, we surmised that there was a need for a dedicated trauma teaching program. Our aim was to determine how confident radiology registrars and radiologists are when reporting trauma and to develop an online teaching trauma case series that will enable them to improve their competency and confidence.

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“…Usually the hemoperitoneum is seen in the Morison pouch, perihepatic space and in the right paracolic gutter and is reabsorbed after 5 to 10 days after injury. The amount of hemoperitoneum have previously been considered an indicator of liver trauma severity, but some recent studies have indicated that the amount of hemoperitoneum does not correlate with failure of nonoperative management [12,17,24,28,29]. Besides hemoperitoneum, CT allows the visualization of contusions, subcapsular hematomas, intraparenchymal hematomas and lacerations to the liver parenchyma [30,31].…”

Section: Discussionmentioning

confidence: 99%

Nonoperative management for patients with grade IV blunt hepatic trauma

Zago¹,

Pereira²,

Calderan³

et al. 2012

World J Emerg Surg

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IntroductionThe treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications.MethodsThis is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessedResultsEighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5%) who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%); one patient developed a tracheal stenosis (secondary to tracheal intubation); one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days.ConclusionsIn our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.

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Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging

Cited by 54 publications

References 29 publications

Classification of liver and pancreatic trauma

Classification of liver and pancreatic trauma

Trauma radiology: The need for a teaching trauma case series

Nonoperative management for patients with grade IV blunt hepatic trauma

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