Hepatic injury

Case contributed by Dr István Kui

Presentation

Fell from the bicycle. Hit by the handlebar.

Patient Data

Age: 9 years
Gender: Male
Ultrasound

A lobulated 6 cm hyperdense parenchyma in the right hepatic lobe. 

CT

Around 6 cm lobulated hypodensity in the right hepatic lobe, including multiple segments (IV, V, VI, VIII, VII) and around 15 mm subcapsular hypodense fluid. 

There is no free fluid in the abdomen.

Case Discussion

The patient was stable when he was taken to the hospital. The young patient had no chronic diseases. After the accident, the ultrasound was made after one hour. Hepatic enzymes were elevated.  We found one part of the right hepatic lobe hyperechogenic, lobulated, diagnosed as a contusion on the ultrasound. The CT scan was made the next day; the patient was still stable, with no pain. We can see the hepatic laceration, the intraparenchymal hematoma, and the subcapsular hematoma. The subcapsular hematoma was not seen one day before on the ultrasound.

The patient was transferred to the intensive care unit for observation, with stable parameters. A couple more ultrasound examinations were performed to control the lesion.

Consulting the AAST classification, we consider grade II because the subcapsular hematoma is between10-50% surface area, and the intraparenchymal hematoma is under 10 cm in diameter.

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Case information

rID: 82913
Published: 11th Oct 2020
Last edited: 11th Oct 2020
Inclusion in quiz mode: Included
Institution: Jósa András Egyetemi Oktatókórház Nyíregyháza