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Hepatic Trauma
Michael R. Aquino, MD, MHSc
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Liver or hepatic laceration, fracture, or injury

        IMAGING

        • General Features

          • CT Findings

            • Ultrasonographic Findings

              • MR Findings

                • Angiographic Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Dodgion CM et al: National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol. J Pediatr Surg. 49(6):1004-8; discussion 1008, 2014
                                            2. Soukup ES et al: Treatment and outcome of traumatic biliary injuries in children. J Pediatr Surg. 49(2):345-8, 2014
                                            3. Ong CC et al: Primary hepatic artery embolization in pediatric blunt hepatic trauma. J Pediatr Surg. 47(12):2316-20, 2012
                                            4. Safavi A et al: Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted? J Pediatr Surg. 46(5):938-41, 2011
                                            5. van der Vlies CH et al: The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review. J Pediatr Surg. 45(5):1044-9, 2010
                                            6. Catalano O et al: CEUS in abdominal trauma: multi-center study. Abdom Imaging. 34(2):225-34, 2009
                                            7. McVay MR et al: Throwing out the "grade" book: management of isolated spleen and liver injury based on hemodynamic status. J Pediatr Surg. 43(6):1072-6, 2008
                                            8. Deluca JA et al: Injuries associated with pediatric liver trauma. Am Surg. 73(1):37-41, 2007
                                            9. Giss SR et al: Complications of nonoperative management of pediatric blunt hepatic injury: diagnosis, management, and outcomes. J Trauma. 61(2):334-9, 2006
                                            10. Yoon W et al: CT in blunt liver trauma. Radiographics. 25(1):87-104, 2005
                                            11. Eubanks JW 3rd et al: Significance of 'blush' on computed tomography scan in children with liver injury. J Pediatr Surg. 38(3):363-6; discussion 363-6, 2003
                                            12. Patten RM et al: CT detection of hepatic and splenic injuries: usefulness of liver window settings. AJR Am J Roentgenol. 175(4):1107-10, 2000
                                            13. Stylianos S: Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. The APSA Trauma Committee. J Pediatr Surg. 35(2):164-7; discussion 167-9, 2000
                                            14. Shilyansky J et al: Delayed hemorrhage after nonoperative management of blunt hepatic trauma in children: a rare but significant event. J Pediatr Surg. 34(1):60-4, 1999
                                            15. Sidhu MK et al: Post-traumatic hepatic pseudoaneurysms in children. Pediatr Radiol. 29(1):46-52, 1999
                                            16. Bond SJ et al: Nonoperative management of blunt hepatic and splenic injury in children. Ann Surg. 223(3):286-9, 1996
                                            17. Moore EE et al: Organ injury scaling: spleen and liver (1994 revision). J Trauma. 38(3):323-4, 1995
                                            18. Mirvis SE et al: Blunt hepatic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology. 171(1):27-32, 1989
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Liver or hepatic laceration, fracture, or injury

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • Ultrasonographic Findings

                                                        • MR Findings

                                                          • Angiographic Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Dodgion CM et al: National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol. J Pediatr Surg. 49(6):1004-8; discussion 1008, 2014
                                                                                      2. Soukup ES et al: Treatment and outcome of traumatic biliary injuries in children. J Pediatr Surg. 49(2):345-8, 2014
                                                                                      3. Ong CC et al: Primary hepatic artery embolization in pediatric blunt hepatic trauma. J Pediatr Surg. 47(12):2316-20, 2012
                                                                                      4. Safavi A et al: Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted? J Pediatr Surg. 46(5):938-41, 2011
                                                                                      5. van der Vlies CH et al: The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review. J Pediatr Surg. 45(5):1044-9, 2010
                                                                                      6. Catalano O et al: CEUS in abdominal trauma: multi-center study. Abdom Imaging. 34(2):225-34, 2009
                                                                                      7. McVay MR et al: Throwing out the "grade" book: management of isolated spleen and liver injury based on hemodynamic status. J Pediatr Surg. 43(6):1072-6, 2008
                                                                                      8. Deluca JA et al: Injuries associated with pediatric liver trauma. Am Surg. 73(1):37-41, 2007
                                                                                      9. Giss SR et al: Complications of nonoperative management of pediatric blunt hepatic injury: diagnosis, management, and outcomes. J Trauma. 61(2):334-9, 2006
                                                                                      10. Yoon W et al: CT in blunt liver trauma. Radiographics. 25(1):87-104, 2005
                                                                                      11. Eubanks JW 3rd et al: Significance of 'blush' on computed tomography scan in children with liver injury. J Pediatr Surg. 38(3):363-6; discussion 363-6, 2003
                                                                                      12. Patten RM et al: CT detection of hepatic and splenic injuries: usefulness of liver window settings. AJR Am J Roentgenol. 175(4):1107-10, 2000
                                                                                      13. Stylianos S: Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. The APSA Trauma Committee. J Pediatr Surg. 35(2):164-7; discussion 167-9, 2000
                                                                                      14. Shilyansky J et al: Delayed hemorrhage after nonoperative management of blunt hepatic trauma in children: a rare but significant event. J Pediatr Surg. 34(1):60-4, 1999
                                                                                      15. Sidhu MK et al: Post-traumatic hepatic pseudoaneurysms in children. Pediatr Radiol. 29(1):46-52, 1999
                                                                                      16. Bond SJ et al: Nonoperative management of blunt hepatic and splenic injury in children. Ann Surg. 223(3):286-9, 1996
                                                                                      17. Moore EE et al: Organ injury scaling: spleen and liver (1994 revision). J Trauma. 38(3):323-4, 1995
                                                                                      18. Mirvis SE et al: Blunt hepatic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology. 171(1):27-32, 1989