E1611. Radiologic Management of Liver Trauma: Diagnostic Imaging and Interventional Treatments
Loma Linda University
Loma Linda University
The liver is the most frequently injured solid organ in abdominal trauma with a reported mortality rate of approximately 4% to 10%. While hemodynamically unstable patients should undergo emergency laparotomy, hemodynamically stable patients tend to undergo non-operative management (NOM). According to the most recent World Society of Emergency Surgery (WSES) guidelines for liver trauma, interventional radiology (IR) techniques such as embolization for bleeding and percutaneous drainage for biliary leaks are considered first-line NOM care for acute injury and delayed complications. For high-grade, unstable hepatic injuries, adjunctive embolization following operative management has also shown a decrease in mortality. Familiarity with imaging features of liver trauma and techniques of management will allow radiologists to diagnose and to act promptly to achieve the best clinical outcome for trauma patients.
Educational Goals / Teaching Points
1. To review the common types of acute injury and delayed complications following liver trauma as well as their appearances on CT imaging.
2. To provide an overview to the WSES liver trauma classification system and the revised WSES 2020 liver trauma management guidelines.
3. To discuss the different IR techniques and their indications for management of blunt liver trauma.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Common types of liver trauma include lacerations, hematomas, active hemorrhage, and juxtahepatic venous injuries. CT findings of periportal low attenuation and flat inferior vena cava may also be present following liver trauma. Delayed complications from NOM may arise such as delayed hemorrhage, hepatic abscess, posttraumatic pseudoaneurysm, hemobilia, biloma, and bile peritonitis. Image-guided interventions such as embolization and percutaneous drainage are considered first-line management for hemodynamically stable patients with symptoms or with arterial blush seen on CT.
Familiarity with typical CT features of liver trauma helps guide prompt detection and management of the acute injury as well as delayed complications. Image-guided interventions are considered an extension of non-operative management of liver trauma and can significantly improve overall clinical outcomes.