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Paediatric Imaging

Haematoma, hepatic

disruption of intrahepatic vessels as a result of blunt or penetrating, accidental or nonaccidental trauma resulting in accumulation of blood within the liver. The ultimate size will depend on factors such as the degree of vascular damage, the tamponading effect of surrounding liver parenchyma, and the haemodynamic and coagulation status of the patient.

Imaging is important in demonstrating the location and extent of the haematoma and in documenting coexisting injuries to other organs.

Ultrasound is quite insensitive for the detection of acute liver parenchymal injuries. An evolving haematoma may have very similar echogenicity to normal liver parenchyma and limitations of the acoustic window because of pain, bowel gas or rib fracture may further decrease sensitivity. Free intraperitoneal fluid may be present, though it is not possible to ascertain its origin.

The most sensitive imaging technique for abdominal trauma in children is dynamic contrast enhanced computed tomography. Normal liver parenchyma is of uniform soft tissue attenuation with branching vascular structures easily visible within its substance. A hepatic haematoma is demonstrated as a focal lesion (usually spherical) of decreased attenuation compared with surrounding normal liver. Its margins may be ill-defined in the acute stage and there will be variable mass effect depending on its size and location. Coexisting liver damage such as laceration, devitalization and subcapsular fluid may be demonstrated and occasionally a sentinel focus of high attenuation may indicate continued haemorrhage from a bleeding vessel.

Ultrasound is useful in the follow-up of liver haematoma, with subsequent liquefaction resulting in a progressively more well defined focal fluid collection. Complications such as bile duct dilatation or the development of further fluid collections may indicate a need for further evaluation of the biliary tract for bile leaks. Pseudoaneurysm and arteriovenous fistula formation are rare complications of hepatic trauma that may be detected by subsequent imaging studies. See haematoma hepatic

DG