Liver Trauma: Classification

LiverLiver TraumaTrauma

ClassificationClassification

ClassificationOrgan Injury Scaling

Vascular Juxtahepatic venous injuries ie. retrohepatic vena cava/central major hepatic veins

Injury DescriptionGrade

Vascular Hepatic AvulsionVI

Laceration Parenchymal disruption involving >75% of hepatic lobe or >3 Coinaud's segments within a single

lobeV

Laceration >3cm parenchymal depth

Laceration Parenchymal disruption involving 25-75% of hepatic lobe or 1-3 Coinaud's segments in a single

lobeIV

Intraparenchymal haematoma >10cm or expanding

Ruptured subcapsular or parenchymal haematoma

Haematoma Subcapsular, >50% surface area or expanding.

III

Laceration 1-3cm parenchymal depth, <10cm length

Haematoma Intraparenchymal, <10cm diameter

Haematoma Subcapsular, 10-50% surface area

II

Laceration Capsular tear, < 1cm parenchymal depth

Haematoma Subcapsular <10% surface area

I


Grade 1 hepatic injury in a 21-year-old man with a stabbing injury to the right upper

quadrant of the abdomen. Axial, contrast-enhanced computed tomography (CT) scan

demonstrates a small, crescent-shaped subcapsular and parenchymal hematoma less than 1

cm thick.

Grade 1 hepatic injury in a 21-year-old man with a stabbing injury to the right upper

quadrant of the abdomen. Axial, contrast-enhanced computed tomography (CT) scan

demonstrates a small, crescent-shaped subcapsular and parenchymal hematoma less than 1

cm thick.

Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.Ali Nawaz Khan, Hemant Vadeyar, Sumaira MacDonald, Muthusamy Chandramohan.

http://emedicine.medscape.com/article/370508-overviewhttp://emedicine.medscape.com/article/370508-overview


A 20-year-old man with systemic lupus erythematosus presented with grade 2 liver injury

after minor blunt abdominal trauma. Nonenhanced axial CT scan at the level of the hepatic

veins shows a subcapsular hematoma 3 cm thick.


after minor blunt abdominal trauma. Nonenhanced axial CT scan at the level of the hepatic

veins shows a subcapsular hematoma 3 cm thick.





after minor blunt abdominal trauma (same patient as in Images above). Axial CT image

through the inferior aspect of the right lobe of the liver demonstrates multiple low-

attenuation lesions in the liver consistent with parenchymal contusion


after minor blunt abdominal trauma (same patient as in Images above). Axial CT image

through the inferior aspect of the right lobe of the liver demonstrates multiple low-

attenuation lesions in the liver consistent with parenchymal contusion




Ronald StewartRonald Stewart

www.trauma.orgwww.trauma.org

Gunshot to right lobe of liver. Grade 2 injury.

Entrance wound Gunshot wound - exit


Grade 3 liver injury in a 22-year-old woman after blunt abdominal trauma. Contrast-

enhanced axial CT scan through the upper abdomen shows a 4-cm-thick subcapsular

hematoma associated with parenchymal hematoma and laceration in segments 6 and 7 of

the right lobe of the liver. Free fluid is seen around the spleen and left lobe of the liver

consistent with hemoperitoneum.

Grade 3 liver injury in a 22-year-old woman after blunt abdominal trauma. Contrast-

enhanced axial CT scan through the upper abdomen shows a 4-cm-thick subcapsular

hematoma associated with parenchymal hematoma and laceration in segments 6 and 7 of

the right lobe of the liver. Free fluid is seen around the spleen and left lobe of the liver

consistent with hemoperitoneum.




Arieh Eitan, Western Galilee Hospital, Nahariyya, IsraelArieh Eitan, Western Galilee Hospital, Nahariyya, Israel


Entrance Gunshot wound to right flank - liver injury gunshot wound

Gunshot to right lobe of liver. Grade 3 injury.


Arieh Eitan, Western Galilee Hospital, Nahariyya, IsraelArieh Eitan, Western Galilee Hospital, Nahariyya, Israel


Entrance Gunshot wound to right flank - liver injury gunshot wound

Grade 3 injury.


Image obtained in a 35-year-old male bouncer after blunt abdominal injury. Nonenhanced

axial CT scan of the abdomen demonstrates a large subcapsular hematoma measuring more

than 10 cm. The high-attenuating areas within the lesion represent clotted blood. The

injury was classified as a grade 4 liver injury.

Image obtained in a 35-year-old male bouncer after blunt abdominal injury. Nonenhanced

axial CT scan of the abdomen demonstrates a large subcapsular hematoma measuring more

than 10 cm. The high-attenuating areas within the lesion represent clotted blood. The

injury was classified as a grade 4 liver injury.




Contrast-enhanced axial CT scan in a 39-year-old man with a grade 4 liver injury shows a

large parenchymal hematoma in segments 6 and 7 of the liver with evidence of an active

bleed. Note the capsular laceration and large hemoperitoneum.

Contrast-enhanced axial CT scan in a 39-year-old man with a grade 4 liver injury shows a

large parenchymal hematoma in segments 6 and 7 of the liver with evidence of an active

bleed. Note the capsular laceration and large hemoperitoneum.




Multisegment infarct (segments 2, 3, 4a, and 4b) in a 40-year-old man who was in a motor

vehicle accident and underwent emergency segmental resection of the right lobe. Note the

sharply demarcated wedge-shaped area of infarction; hence, the classification as grade 4

Multisegment infarct (segments 2, 3, 4a, and 4b) in a 40-year-old man who was in a motor

vehicle accident and underwent emergency segmental resection of the right lobe. Note the

sharply demarcated wedge-shaped area of infarction; hence, the classification as grade 4




liver laceration (blunt trauma)liver laceration (blunt trauma)

Ronald StewartRonald Stewart


Grade 4 injury.


Grade 5 injury in a 36-year-old man who was involved in a motor vehicle accident

demonstrates global injury to the liver.

Grade 5 injury in a 36-year-old man who was involved in a motor vehicle accident

demonstrates global injury to the liver.




liver laceration with laceration of retrohepatic vena cava and right hepatic veinliver laceration with laceration of retrohepatic vena cava and right hepatic vein

Horacio A. Massotto, Costa RicaHoracio A. Massotto, Costa Rica


Grade 5 injury.

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Liver Trauma: Classification

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