Answer

Liver trauma

The CT demonstrates an extensive liver laceration through the right lobe of the liver. There is widespread free fluid within the peritoneal space seen around the liver and also the spleen.

The liver is the second most commonly injured intra-abdominal organ. This is partly related to its large size, fixed position and relative friability. If the liver capsule is torn, intra-peritoneal haemorrhage can be extensive due to the rich dual blood supply of the liver. Delayed rupture is not encountered following liver trauma unlike splenic trauma. The most commonly injured site is the posterior segment of the right lobe. Left lobe injuries are less common but are associated with injuries of other retroperitoneal structures, e.g. duodenum and pancreas. On CT, liver lacerations appear as non-enhancing irregular, linear, round, or branching regions of low attenuation. Lacerations can extend to the visceral surface sometimes as irregular jagged lines. Intra-parenchymal haematomas appear as mass like, low density non-enhancing regions (Fig. 3.19). Subcapsular haematomas extend around the capsule in a lenticular pattern compressing the underlying liver. Periportal low density is frequently encountered in the setting of blunt abdominal trauma and has been linked to aggressive fluid resuscitation.

Surgical series have demonstrated that 80% of traumatic liver injuries can be treated conservatively unless there is haemodynamic instability. Active haemorrhage detected on CT can be treated by catheter embolisation. Complications following liver trauma include recurrent bleeding, pseudoaneurysm formation, bile duct injury, biloma and

Fig. 3.18 Quiz case.

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Fig. 3.19 Liver trauma. There is a large non-enhancing laceration/haematoma in the right lobe of liver with haemoperitoneum around both the liver and spleen.

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