Traumatic hepatic injury in pregnancy

Single foetus within the uterus with a cephalic presentation. Uterine fundus above the umbilicus, in keeping with stated gestation. The placenta is predominantly sited anteriorly, and appears well away from the cervix.

An ill-defined region of non-enhancing hypodensity within the periphery of liver segment 8 is consistent with a traumatic liver injury. No active bleeding identified. No other focal hepatic lesion or liver abnormality identified. Severe fatty liver. The gallbladder, pancreas, spleen, kidneys and adrenal glands are unremarkable. No free fluid or pneumoperitoneum. An abdominal subcutaneous infra-umbilical transverse band of fat stranding presumably relates to seatbelt trauma. This currently overlies the fetal head.

Multiple right rib fractures (6th-9th), partly imaged, with some displacement. No left-sided rib fracture identified. Minor dependent lung changes. Very small right pleural effusion. Normal alignment of the lumbar spine and pelvis. No fracture identified.

IMPRESSION

• Single foetus within the uterus, of dimensions in keeping with a 25-week gestation. No CT signs of placental abruption.
• Ill-defined hypodensity within liver segment 8 is consistent with a traumatic liver injury (AAST grade II). No active bleeding or hemoperitoneum demonstrated.
• Infra-umbilcial anterior abdominal wall seat belt sign.
• Multiple right-sided rib fractures (6th to 9th), partly imaged, some displaced. Small right pleural effusion.