IS Case 71: Liver Laceration and Right Hepatic Artery Embolization

Wade Hedegard, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-19

History

A 19-year-old female presents after a sledding accident.

Findings

Emergent CT scan of the chest, abdomen and pelvis demonstrate a large low density liver laceration in the dome of the liver with an active blush of contrast. There is also significant hemoperitoneum. A selective celiac arteriogram was performed demonstrating active extravasation of contrast from a branch of the right hepatic artery. A super-selective angiogram of the right hepatic artery better delineates the bleeding vessel. Transcatheter occlusive therapy was performed with multiple microcoils placed proximal to the area of extravasation. Post-embolization celiac angiogram demonstrates no active extravasation or arterial blush.

Discussion

Hepatic trauma is a relatively common injury that carries a high morbidity and mortality in those patients with active bleeding. The main types of hepatic trauma include subcapsular hematoma and lacerations. Hemobilia, hemoperitoneum and self-limited hepatic hematomas are the most common presentations of traumatic hepatic hemorrhage, although occasionally an arterial blush indicating active extravasation may be seen on CT. The pooling of contrast material locally in the liver parenchyma or freely in the peritoneal space has been recognized as a specific sign of active bleeding that warrants embolization. Early detection of arterial contrast material extravasation on CT is important because it allows arterial embolization to be performed before the patient becomes hemodynamically unstable. Several embolization techniques have been described with a variety of embolic materials including cyanoacrylate glue, Gelfoam particles and microcoils. Superselective catheterization of the bleeding vessel using a microcatheter allows for highly selective embolization that spares nonaffected liver. Occlusive therapy provides an effective and superior alternative to surgery for the control of acute hepatic arterial bleeds. Transcatheter embolizations are performed in the setting of trauma for arterial bleeding, fistula, or major hepatic arterial vascular abnormality including occlusion or focal luminal irregularity.

References

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  2. DiGiacomo JC, McGonigal MD, Haskal ZJ, Audu PB, Schwab CW. Arterial bleeding diagnosed by CT in hemodynamically stable victims of blunt trauma. J Trauma. 1996 Feb;40(2):249-52. [PMID: 8637073]
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  4. Petroianu A. Transcatheter arterial embolization for hemorrhage caused by injury of the hepatic artery. J Gastroenterol Hepatol. 2005 Jul;20(7):973-4. [PMID: 15955202]

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