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Hepatic Injuries

  • Lina Bartolini
  • Ginevra Danti
  • Claudio Raspanti
  • Gloria Addeo
  • Diletta Cozzi
  • Margherita Trinci
  • Vittorio Miele
Chapter

Abstract

Liver is the second intraperitoneal parenchymal organ involved in trauma, with a prevalence of 20%. A relevant decrease in high-energy trauma associated deaths was related to the diffusion and advancement of imaging techniques and the development of Trauma Centers specialized in the critical patient management. In particular during the last decades, there has been a substantial decrease in deaths from liver injury, currently estimated in about 15% related to major injuries. The introduction of modern imaging techniques integrated with each other such as ultrasonography (US) and contrast-enhanced multidetector computed tomography (CE-MDCT) has been of great importance because they allow a full evaluation of any kind of lesion of whole body, they reveal the presence of free fluid and the presence of the prognostic factors as vascular lesions or active bleeding, which can change the management of the patient. With the purpose to depict the presence of two of the principals causes of death in the “golden hour” that are pneumothorax and hemoperitoneum, during the first clinical evaluation of a severe trauma the patient is undergoing to an Extended Focused Assessment with Sonography for Trauma (E-FAST). This technique has high sensibility in detecting even small amount of pneumothorax and hemoperitoneum but its sensitivity decreases in the identification of abdominal solid organ lesions and hemoretroperitoneum. MDCT is the fundamental diagnostic examination for polytrauma patients in stable hemodynamic conditions and shows high sensitivity (approximately 99%), specificity (about 96.8%), and diagnostic accuracy (about 97.6%) in the diagnosis of liver damage caused by trauma. The MDCT allows in a very short time a panoramic study of the abdominal area giving an indication about the management (nonoperative management, trans-arterial embolization or surgery).

Only in case of minor localized trauma, the first method of imaging which is used to evaluate the patient, mostly in younger, is contrast-enhanced ultrasound (CEUS). The use of the contrast medium improves accuracy of the basal US in detecting parenchymal liver lesion, shows the integrity of the liver capsule, and may reveal the presence of bleeding and of free fluid.

If liver injury is demonstrated at CEUS, a contrast-enhanced CT is needed to evaluate the patient. CEUS and MRI may have a role in the follow-up of the stable patient.

Not only diagnosis but also the type of therapeutic approaches has radically changed in the last years. Currently, about 80–89% of liver injuries are treated conservatively, with a success rate which goes from 85 to 94%.

Keywords

Trauma Trauma imaging Emergency radiology Blunt abdominal trauma Hepatic trauma Mechanism of trauma Extended focused assessment with sonography for trauma (E-FAST) Contrast-enhanced ultrasound (CEUS) Computed tomography (CT) Management Prognoses 

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Lina Bartolini
    • 1
  • Ginevra Danti
    • 1
  • Claudio Raspanti
    • 2
  • Gloria Addeo
    • 1
  • Diletta Cozzi
    • 1
  • Margherita Trinci
    • 3
  • Vittorio Miele
    • 1
  1. 1.Department of RadiologyCareggi University HospitalFlorenceItaly
  2. 2.Department of Interventional RadiologyCareggi University HospitalFlorenceItaly
  3. 3.Department of Emergency RadiologyS. Camillo HospitalRomeItaly

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