Presentation
Motorbike accident 60 km/hr; hypotensive at scene; RUQ tender.
Patient Data
There is a large liver laceration extending through the majority of the right lobe (predominantly segments VII and VII also extending inferiorly into segment VI) with a moderate to large subcapsular hematoma measuring 2.5cm in width and greater than 10cm in length.
The right hepatic vein and posterior branch of the right main portal vein run into the laceration without evidence of active extravasation.
2.0 x 1.6 cm right adrenal hematoma.
Perisplenic hematoma without discrete splenic injury.
Conclusion:
- Grade III-IV traumatic liver injury.
- Right adrenal hematoma.
- Perisplenic hematoma without obvious splenic injury.
Case Discussion
The liver is a frequently injured organ in blunt abdominal organ but most often management is non-operative.
Adrenal gland can also be commonly injured but is sometimes difficult to determine whether an adrenal lesion is a contusion/hemorrhage or pre-existing. Either review prior imaging or arrange follow-up.