Pediatric Liver Trauma

Etiology: Blunt abdominal trauma
Imaging CT:
— Spectrum is contusion to laceration (stellate or bearclaw or fracture) to hematoma (subcapsular or intraparenchymal) to vascular pedicle disruption
— Hemorrhage can dissect into retroperitoneum
— Does not always have hemoperitoneum
— Lacerations around falciform ligament can be difficult to identify
— Active arterial bleeding can be seen with blush of extravasated contrast adjacent to injured artery which forms a puddle that does not conform to a blood vessel
Note: Liver infarcts are uncommon due to liver’s dual blood supply through portal vein and hepatic artery
Note: American Association for the Surgery of Trauma (AAST) Injury Scoring Scale used to grade injury in order to help determine prognosis
DDX: Periportal halo is a mimic of liver trauma and appears as areas of low density surrounding the portal veins and is due to fluid accumulation or lymphatic dilation around the portal triads from aggressive fluid resuscitation and is not specific for trauma
Complications:
Treatment: Low grade lacerations are treated conservatively
Clinical: Posterior segment of right lobe of liver injured most often

Radiology Cases of Liver Trauma

Radiology Cases of Incorrect CT Technique Without the Use of Intravenous Contrast for the Assessment of Blunt Abdominal Trauma

CT without intravenous contrast using incorrect technique for the assessment of blunt abdominal trauma — Axial CT without contrast of the abdomen shows grossly unremarkable unenhanced solid organs of the abdomen without free air or free fluid.

Radiology Cases of Periportal Halo Mimicking Liver Trauma

CT of periportal halo — Axial CT with contrast of the abdomen shows no laceration in the liver and linear low density surrounding the portal venous system.

Radiology Cases of Liver Trauma

CT of bearclaw laceration of the liver — Axial CT with contrast of the abdomen shows a low density bear claw shaped lesion in the right lobe of the liver that is lateral to and inferior to the gall bladder.

CT of liver trauma / liver laceration — Axial CT with contrast of the abdomen shows an area of low density in the right lobe of the liver and a large amount of free fluid in the pelvis.

CT of inhomogenous enhancement of the spleen and liver laceration — Axial CT with contrast of the abdomen shows a stellate area of low density in the right lobe of the liver. The spleen does not have a laceration, instead it demonstrates inhomogenous opacification due to the image being obtained in the arterial phase – note how dense the contrast in the aorta is.

CT of liver laceration — Axial CT with contrast of the abdomen shows a low density lesion in the posterior aspect of the right lobe of the liver.

CT of liver laceration — Axial CT with contrast of the abdomen shows a low density triangular shaped lesion in the middle of the liver.

Radiology Cases of Liver Trauma and Adrenal Hemorrhage

CT of liver laceration and adrenal hemorrhage — AXR AP (above) obtained after an outside upper GI exam which demonstrated normal bowel rotation shows contrast filling multiple dilated loops of small bowel. Initial AP image from an enema (below left) shows a microcolon with contrast almost reaching the cecum. Later image from the enema (below right) shows reflux of contrast into dilated loops of distal ileum in the right lower quadrant.

CT of liver laceration — Axial CT with contrast of the abdomen shows two low density poorly circumscribed lesions in the right lobe of the liver.

CT of adrenal trauma / adrenal laceration and liver trauma / liver laceration — Axial CT with contrast of the abdomen shows a large amount of fluid in the region of the right adrenal gland and areas of low density in the middle and posterior aspects of the right lobe of the liver.

Radiology Cases of Liver Trauma and Autosomal Dominant Polycystic Kidney Disease

CT of autosomal dominant polycystic kidney disease — Axial CT with contrast of the abdomen (above left) shows a large laceration in the middle of the right lobe of the liver that is associated with a large amount of hemoperitoneum inferior to the liver (below left). Coronal CT (right) shows multiple large cysts scattered throughout the cortex and medulla in both kidneys.