Hepatic contusion - importance of the arterial phase

Case contributed by Dr Chris O'Donnell

Presentation

Pedestrian hit by a four wheel drive on the right side at 80km/hr. Right upper quadrant pain.

Patient Data

Age: 15 years
Gender: Female

Arterial and portal venous phases

CT

Gross reduction in perfusion of the right lobe of liver with normal hepatic arterial branches ie no occlusion or dissection, with "filling in" on the portal venous phase leaving only relatively minor linear defects due to parenchymal laceration or bursting. No capsular disruption or perihepatic hematoma.  Appearances indicate considerable contusion to the right lobe of liver that is invisible on the portal phase of the study.

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