Grade III hepatic injury
Blunt abdominal trauma.
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Complex hepatic laceration. Contrast-enhanced CT scan shows multiple linear lacerations (“bear claw” lacerations) in the left hepatic lobe. There is a deep laceration almost separating the left lobe segments.Note the portal vein branch traversing and anchoring the detached lacerated left lobe segments.segment. There is also evidence of haemoperitoneum in right sub-phrenic space.
The major CT features of blunt liver trauma are lacerations, subcapsular and parenchymal hematomas, active hemorrhage, and juxtahepatic venous injuries. Minor CT features include periportal low attenuation and a flat inferior vena cava .
Hepatic lacerations are the most common type of parenchymal liver injury and appear as irregular linear or branching low-attenuation areas at contrast-enhanced CT . Lacerations can be classified as superficial (≤3 cm in depth) or deep (>3 cm). Lacerations that extend to the posterosuperior region of segment VII, the bare area of the liver, may be associated with retroperitoneal hematomas around the IVC and accompanied by adrenal hematoma . Lacerations that extend to the porta hepatis are commonly associated with bile duct injury and are thus likely to lead to the development of a biloma