Spiral CT Manifestations of Blunt Liver Trauma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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XU Jun ¹ , SONG Bin ² , WU Bi. ²

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Keywords：

Liver Trauma Tomography/X-ray computed

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【Abstract】ObjectiveTo investigate the spectrum of spiral CT imaging findings of blunt liver trauma.
MethodsClinical data of 17 patients with blunt liver trauma were retrospectively collected. All patients underwent standardized spiral CT examination of the upper abdomen, which include plain scan, arterial phase and portal venous phase acquisition. The morphology, density and integrity of liver parenchyma and intrahepatic venous structures were carefully observed, as well as regions of porta hepatis, peritoneal cavity and retroperitoneal space.
ResultsTwelve cases (70.6%) developed hepatic parenchymal laceration. There were 9 cases (52.9%) of traumatic hematoma, among which 5 were intraparenchymal and 4 were subcapsular. One case (5.9%) showed active bleeding within an intrahepatic hematoma, while two cases (11.8%) had injury (laceration) of hepatic veins. There were 7 patients (41.2%) who demonstrated the so-called “halo sign” around the intrahepatic portal branches. Thirteen patients were associated with peritoneal fluid (blood) collection, 3 with hematoma or hemorrhage of the right adrenal gland, 8 with plural effusion and 3 cases with rib fractures of right lower chest.
ConclusionCT imaging findings of blunt liver trauma include parenchymal laceration, intraparenchymal and /or subcapsular hematomas, active hemorrhage, and tear of hepatic veins. Plain CT scan and contrastenhanced dualphase acquisition is very important for the comprehensive evaluation of patients with blunt liver trauma.

Citation： XU Jun,SONG Bin,WU Bi.. Spiral CT Manifestations of Blunt Liver Trauma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2005, 12(4): 415-418下转421. doi: Copy

1.	3Pachter HL, Spencer FC, Hofstetter SR, et al. Significant trends in the treatment of hepatic trauma. Experience with 411 injuries [Ｊ]. Ann Surg, 1992; 215(5)∶492 （下转第421页）（上承第418页）.
2.	Matthes G, Stengel D, Seifert J, et al. Blunt liver injuries in polytrauma: results from a cohort study with the regular use of wholebody helical computed tomography [Ｊ]. World J Surg, 2003; 27(10)∶1124.
3.	Croce MA, Fabian TC, Menke PG, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial [Ｊ]. Ann Surg, 1995; 221(6)∶744.
4.	Pachter HL, Hofstetter SR. The current status of nonoperative management of adult blunt hepatic injuries [Ｊ]. Am J Surg, 1995; 169(4)∶442.
5.	Pachter HL, Knudson MM, Esrig B, et al. Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients [Ｊ]. J Trauma, 1996; 40(1)∶31.
6.	Malhotra AK, Fabian TC, Croce MA, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s [Ｊ]. Ann Surg, 2000; 231(6)∶804.
7.	David Richardson J, Franklin GA, Lukan JK, et al. Evolution in the management of hepatic trauma: a 25year perspective [Ｊ]. Ann Surg, 2000; 232(3)∶324.
8.	Velmahos GC, Toutouzas K, Radin R, et al. High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ [Ｊ]. Arch Surg, 2003; 138(5)∶475.
9.	Goffette PP, Laterre PF. Traumatic injuries: imaging and intervention in posttraumatic complications (delayed intervention) [Ｊ]. Eur Radiol, 2002; 12(5)∶994.
10.	Willmann JK, Roos JE, Platz A, et al. Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma [Ｊ]. AJR Am J Roentgenol, 2002; 179(2)∶437.
11.	Poletti PA, Mirvis SE, Shanmuganathan K, et al. CT criteria for management of blunt liver trauma: correlation with angiographic and surgical findings [Ｊ]. Radiology, 2000; 216(2)∶418.
12.	Shanmuganathan K, Mirvis SE. CT scan evaluation of blunt hepatic trauma [Ｊ]. Radiol Clin North Am, 1998; 36(2)∶399.
13.	Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling: spleen and liver (1994 revision) [Ｊ]. J Trauma, 1995; 38(3)∶323.
14.	Delgado Millan MA, Deballon PO. Computed tomography, angiography, and endoscopic retrograde cholangiopancreatography in the nonoperative management of hepatic and splenic trauma [Ｊ]. World J Surg, 2001; 25(11)∶1397.
15.	Poletti PA, Wintermark M, Schnyder P, et al. Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation) [Ｊ]. Eur Radiol, 2002; 12(5):969.

1. 3Pachter HL, Spencer FC, Hofstetter SR, et al. Significant trends in the treatment of hepatic trauma. Experience with 411 injuries [Ｊ]. Ann Surg, 1992; 215(5)∶492 （下转第421页）（上承第418页）.
2. Matthes G, Stengel D, Seifert J, et al. Blunt liver injuries in polytrauma: results from a cohort study with the regular use of wholebody helical computed tomography [Ｊ]. World J Surg, 2003; 27(10)∶1124.
3. Croce MA, Fabian TC, Menke PG, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial [Ｊ]. Ann Surg, 1995; 221(6)∶744.
4. Pachter HL, Hofstetter SR. The current status of nonoperative management of adult blunt hepatic injuries [Ｊ]. Am J Surg, 1995; 169(4)∶442.
5. Pachter HL, Knudson MM, Esrig B, et al. Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients [Ｊ]. J Trauma, 1996; 40(1)∶31.
6. Malhotra AK, Fabian TC, Croce MA, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s [Ｊ]. Ann Surg, 2000; 231(6)∶804.
7. David Richardson J, Franklin GA, Lukan JK, et al. Evolution in the management of hepatic trauma: a 25year perspective [Ｊ]. Ann Surg, 2000; 232(3)∶324.
8. Velmahos GC, Toutouzas K, Radin R, et al. High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ [Ｊ]. Arch Surg, 2003; 138(5)∶475.
9. Goffette PP, Laterre PF. Traumatic injuries: imaging and intervention in posttraumatic complications (delayed intervention) [Ｊ]. Eur Radiol, 2002; 12(5)∶994.
10. Willmann JK, Roos JE, Platz A, et al. Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma [Ｊ]. AJR Am J Roentgenol, 2002; 179(2)∶437.
11. Poletti PA, Mirvis SE, Shanmuganathan K, et al. CT criteria for management of blunt liver trauma: correlation with angiographic and surgical findings [Ｊ]. Radiology, 2000; 216(2)∶418.
12. Shanmuganathan K, Mirvis SE. CT scan evaluation of blunt hepatic trauma [Ｊ]. Radiol Clin North Am, 1998; 36(2)∶399.
13. Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling: spleen and liver (1994 revision) [Ｊ]. J Trauma, 1995; 38(3)∶323.
14. Delgado Millan MA, Deballon PO. Computed tomography, angiography, and endoscopic retrograde cholangiopancreatography in the nonoperative management of hepatic and splenic trauma [Ｊ]. World J Surg, 2001; 25(11)∶1397.
15. Poletti PA, Wintermark M, Schnyder P, et al. Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation) [Ｊ]. Eur Radiol, 2002; 12(5):969.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Spiral CT Manifestations of Blunt Liver Trauma

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