Grade I liver injury

   January 4, 2021  Posted in Abdomen, Trauma

Case contribution: Dr Radhiana Hassan

Clinical:

  • A 13 years old boy
  • Motorcycle skidded
  • Vital signs stable
  • Complaint of vague pain at abdomen
Contrast enhanced CT of upper abdomen in axial plane soft tissue window

CT scan findings:

  • Multiple short lacerations in left lobe of liver (red arrows)
  • These lacerations do not extend to capsular surface
  • A short laceration near the hilum (yellow arrow) less than one cm
  • No intraparenchymal hematoma, no free fluid seen

Progress of patient:

  • Patient was managed conservatively for the liver injury
  • However he had prolong admission due to multiple injuries:
    • open fracture right tibia and fibula with external fixator complicated with osteomyelitis
    • Closed fracture of midshaft femur, plating done
    • Post linsfrac amputation and SSG of right foot

Diagnosis: Grade I liver injury

Discussion:

  • The liver is the largest solid abdominal organ with a relatively fixed position is prone to injury.
  • The liver is the second most commonly injured organ in abdominal trauma.
  • CT has high sensitivity and specificity for the detection of liver injury.
  • The CT features of blunt liver injuries are lacerations, subcapsular and parenchymal haematomas, active haemorrhage and vascular injuries.
  • Grade I liver injury according to AAST liver injury grading system refers to subcapsular hematoma of <10% surface area or laceration with capsular tear <1 cm in parenchymal
    depth.
Author: radhianahassan