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CT Criteria for Management of Blunt Liver Trauma: Correlation with Angiographic and Surgical Findings. From the Departments of Diagnostic Radiology and Interventional Radiology University of Maryland Medical Center and Shock Trauma Cente
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From the Departments of Diagnostic Radiology and Interventional Radiology University of Maryland Medical Center and Shock Trauma Cente
Pierre A. Poletti, MD, Stuart E. Mirvis, MD, Kathirkamanathan Shanmuganathan, MD
Karen L. Killeen, MD,Douglas Coldwell, MD
Radiology 2000; 216:418–427
Transverse CT scan shows right lobe liver lacerations (arrows) extending to the right and middle hepatic veins at their confluence with the inferior vena cava.
In another patient, the common hepatic artery was not selectively catheterized for anatomic reasons, and, therefore, the angiographic study was suboptimal because the contrast material injection was limited to the celiac trunk.
However, because the angiographic examination was considered to be a reference standard for the present study and because the patient was treated successfully without surgery, that CT study also was considered to be false-positive.
Two focal areas of hemorrhage (arrowheads in a) are seen within the hematoma. The selective hepatic angiogram (not shown) did not show evidence of hepatic hemorrhage.
CT scan shows a focal area of normally enhancing hepatic parenchyma (straight arrow) within a grade 4 right liver lobe laceration (curved arrows) mimicking a site of active hemorrhage.
The selective hepatic angiogram (not shown) did not show evidence of hepatic bleeding.
At initial interpretation of the transverse CT scan, a well-circumscribed focal area of high attenuation (arrow) seen within a grade 4 hepatic laceration (arrowheads) was falsely considered to be a hepatic pseudoaneurysm.
The selective hepatic angiogram (not
shown) did not demonstrate a hepatic arterial pseudoaneurysm.
At retrospective review of this scan, these findings were found to be a branch of the normal right portal vein traversing through the hepatic laceration.
Transverse CT scans show a wedge-shaped, low-attenuating area (open arrows) in the right hepatic lobe drained by the middle hepatic vein.
A hepatic laceration (solid arrow in a) extends into the region of the middle hepatic vein (curved arrow in b), which is thrombosed and not enhancing at CT.
Free intraperitoneal blood (arrowheads) is seen around the inferior vena cava and the liver.
At surgery, the middle hepatic vein was avulsed from the inferior vena cava and actively bleeding.