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Liver laceration - AAST grade V

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Motor vehicle collision. Two quadrant positive FAST. Tachycardic but normotensive.

Patient Data

Age: 25 years
Gender: Male

Massive liver lacerations extending through segment 4-8 to the hilum. Extravascular pooling of contrast on the portal venous phase in keeping with active bleeding . Subcapsular hematoma in liver segments 6/7 with few hyperdense foci on the portal venous phase. Large hemoperitoneum.

Few thickwalled loops of jejunum in the left upper quadrant are non-specific. Remainder of the bowel is unremarkable. Distended bladder. 

Right lower lobe airspace opacification - aspiration +/- contusion. 

Case Discussion

Remarkably the patient was relatively haemodynamically stable for such a severe injury. Angiography was performed (not shown), which did not demonstrate active arterial bleeding and the patient was managed conservatively. 

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