287.Hepatic trauma, three different patients (肝脏损伤)

每天朗读一段医学影像学英语文章

A, There is a lenticular fluid collection involving the lateral portion of the right lobe of the liver that represents a subcapsular hematoma (solid black arrow). A laceration of the right lobe is also present (dotted black arrow). 

B, There are multiple lacerations of the right lobe of the liver (black circle).

C, Active extravasation of contrast-enhanced blood (solid black arrow) is seen from a large intrahepatic laceration with hematoma (dotted black arrow) and there is both subcapsular blood and hemoperitoneum (solid white arrow).

Note

1. lenticular /len'tɪkjʊlə/adj.透镜的

2. subcapsular /ˌsʌb'kæpsjulə/adj.包膜下的

3. hemoperitoneum /'hi:mə,peritə'ni:əm/n.腹腔积血

Extensive Reading

·The liver is discussed first because it is actually the most frequently injured organ if both penetrating and blunt traumas are included together. The liver is the largest intraabdominal organ and is fixed in position, making it especially susceptible to injury. Injuries to the liver account for the majority of deaths from abdominal trauma. 

·The posterior aspect of the right lobe is injured most frequently. Most hepatic injuries are associated with blood in the peritoneal cavity (hemoperitoneum). 

·Contrast-enhanced CT is the study of choice and, because of its ability to demonstrate both the nature and extent of the trauma, the overwhelming majority of patients with liver trauma are now managed conservatively and do not require surgery. 

·CT findings in hepatic trauma (Fig. 17-7): 

oSubcapsular hematoma. Lenticular fluid collections that conform to the shape of the outer contour of the liver but which frequently flatten the adjacent liver parenchyma. Most occur anterolaterally over the right hepatic lobe. 

oLacerations. Most common finding. Irregularly marginated, low attenuation, linear or branching defects, usually at the periphery. "Fracture" is a term that has been used to describe a laceration that avulses a section of the liver. 

oIntrahepatic hematomas. Focal, high attenuation lesions first caused by blood; hematomas may progress to low attenuation, masslike lesions filled with serous fluid. 

oWedge-shaped defects. Devascularized sections of liver parenchyma that do not contrast-enhance. 

oContusions. A term used to describe an area of minimal parenchymal hemorrhage; they are lower in attenuation than the surrounding liver and have indistinct margins. 

oPseudoaneurysms and acute hemorrhages. Irregular collections of high attenuation, extravasated contrast that often require angiography with embolization or surgery. 

来源：每天朗读一段医学影像学英语文章

圈主

深圳市人民医院放射科副主任医师杨敏洁

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