M. Paetzel (Cleveland/USA)  

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11 Years  

Male  

Abdomen-Liver  

physical  

11 year old boy, fall from a tree, abdominal pain, therefore admission under presumption of a blunt abdominal trauma.  

Parynchmal hemorrhage of the liver without affection of the capsule appears often near the teres hepatis ligament, due to a natural fixation, where the gravitational effects are appearant.

The lesion is scaled as a Grade I of the Organ Injury Scale (OIS).

The free intraperitoneal fluid shows that the rupture is not solely intraparenchymal. (A hemorrhage that was within the liver capsule (subcapsular hemorrhage) was not seen, so through this proof of free fluids, a lesion in the liver capsule must be assumed.)

On the whole, only about a half of the organ's lesions were detected with ultrasound. Only through the use of CT or MRI (without contrast!) could the hemorrhages be correctly found.

Ultrasound could thus be seen as the main modality of detecting intraperitoneal fluid.  

<- view Ultrasound 1

Ultrasound 1: Evidence of a small amount of free intraperitoneal fluid in the suprabubic level.





<- view Ultrasound 2

Ultrasound 2: Presentation of small amount of free intraperitoneal fluid in the suprabubic level.




<- view Ultrasound 3

Ultrasound 3: Evidence of small amount of free intraperitoneal fluid in the Morrison-space.




<- view Ultrasound 4

Ultrasound 4: Liver: Presentation of a mild diffuse increase of echogenity lateral to the Lig. teres hepatis. This finding cannot be definitely categorized as pathologic.




<- view MRI 1

MRI 1: T2-weighted (HASTE) transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis.





<- view MRI 2

MRI 2: T1-weighted (FLASH) without contrast transversal: Presentation of a mild diffuse increase of signal intensity right lateral to the Ligamentum teres hepatis..





<- view CT 1

CT 1: transversal after KM: Presentation of a mild, but after contrast significantly demarcated hypoperfusion right lateral to the Ligamentum teres hepatis.


 

Imaging including endoscopy  

none  

In slight parenchymal hemorrhages, there is often no other findings. Posttraumatic cysts or bilomas are rare.  

N/A  

N/A  

N/A  

Traumatic, liver hemorrhage, grade I, bleeding, bleed, hemorrhage, liver, fluid, trauma, traumatic grade I liver hemorrhage, child, childhood, pediatric radiology  

M Paetzel. Traumatic liver hemorrhage grade I. PedRad [serial online] vol 3, no. 11.
URL: www.PedRad.info/?search=20031110211430