Liver laceration - AAST grade IV

Case contributed by Ian Bickle
Diagnosis almost certain


Involved in an industrial accident. Patient scanned promptly after arrival in A & E.

Patient Data

Age: 35 years
Gender: Male

Large laceration in the right lobe of the liver with a perihepatic hematoma. 

Active contrast extravastation from the liver parenchyma into the perihepatic space

Case Discussion

 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.

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