Liver laceration: AAST grade IV
This male in his 30's was involved in an industrial accident. Patient scanned promptly after arrival in A & E.
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Large laceration in the right lobe of the liver with a perihepatic hematoma.
Active contrast extravastation from the liver parenchyma into the perihepatic space
Contrast enhanced CT (be it single or multiphase) is the imaging modality of choice in the assessment of blunt trauma to the abdomen. Splenic and liver injuries are most common.
Clinical classication systems, such as that by the American Association for the Surgery of Trauma, have been developed, in which CT plays an important role.
This has a classification from I - VI, which ranges from a small parenchymal tear and subcapsular hematoma (I) through to hepatic avulsion (VI).
In Grade IV, the laceration causes disruption to 25-75% of a hepatic lobe or 1-3 Couinaud segments within a single lobe.
- Cohn SM et al. Computed tomography grading systems poorly predict the need for intervention after spleen and liver injuries. Am Surg. 75(2):133-9, 2009.