Hepatic injury: AAST grade III

Case contributed by Dr G Balachandran


Blunt abdominal trauma.

Patient Data

Age: 30 years
Gender: Male


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 hemoperitoneum in right sub-phrenic space.

Case Discussion

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

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Case information

rID: 15629
Published: 30th Oct 2011
Last edited: 12th Dec 2017
Inclusion in quiz mode: Included

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