Subcapsular liver hematoma with embolization

Case contributed by RMH Core Conditions

Presentation

Football injury. RUQ pain.

Patient Data

Age: 25 years
Gender: Male

A large subcapsular liver hematoma is identified measuring approximately 14.0 x 17.0 x 19.5 cm (w x AP x h), with layering of high and low density suggestive of blood of different ages.

At the anteromedial aspect of the hematoma, there are a few small areas of active contrast extravasation.Marked mass effect on the adjacent liver which now demonstrates a scalloped contour, as well as mild mass effect on the right kidney, superior pole.

A linear hypodensity courses through the right lobe of liver, in the anteroposterior plane, approaching the liver hilum. At the mid portion of this hypodensity a tiny contrast blush is seen adjacent to the middle hepatic vein. A 10 mm linear defect is also seen within the peripheral contour of the right hepatic liver (liver segment VII/ VIII). Large increase in free intraperitoneal fluid.

No further visceral injury identified. No free intraperitoneal gas.

 

DSA (angiography)

Right hepatic artery super-selection. This showed extensive ill-defined inferior right hepatic lobe hemorrhage, particularly with focal extravasation pooling around the lower margin of segment 6. Given the ill-defined nature of the hemorrhage, the decision was made to perform Gelfoam (rather than coil) embolization of the right hepatic artery to stasis.

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