肝脏钝性伤的CT表现

Spiral CT Manifestations of Blunt Liver Trauma

目的探讨肝脏钝性外伤所造成肝脏损伤的螺旋CT表现征象。方法收集17例肝脏钝性外伤病例的临床与CT资料。所有病例均行标准化的上腹部螺旋CT平扫及双期增强扫描,着重观察肝脏实质、肝内血管及胆管的形态、密度和完整性,同时也观察肝门结构、肝周及腹膜腔、腹膜后等区域。结果本组12例发现肝实质裂伤(70.6%);9例发现血肿(52.9%),其中5例为肝实质内血肿,4例为肝包膜下血肿;1例(5.9%)发现血肿内的活动性出血;2例(11.8%)发现肝静脉的损伤(撕裂);7例(41.2%)显示肝内门静脉分支周围的“晕环”征。本组有13例合并腹腔内积液(血),3例合并右侧肾上腺血肿,8例合并胸水,3例合并肋骨骨折。结论肝脏钝性损伤可出现肝实质的裂伤、血肿、活动性出血以及肝内静脉的撕裂等表现。CT平扫和双期增强扫描具有重要的诊断价值。

Objective To investigate the spectrum of spiral CT imaging findings of blunt liver trauma.Methods Clinical data of 17 patients with blunt liver trauma were retrospectively collected. All patients underwent standardized spiral CT examination of the upper abdomen, which include plain scan, arterial phase and portal venous phase acquisition. The morphology, density and integrity of liver parenchyma and intrahepatic venous structures were carefully observed, as well as regions of porta hepatis, peritoneal cavity and retroperitoneal space.Results Twelve cases (70.6%) developed hepatic parenchymal laceration. There were 9 cases (52.9%) of traumatic hematoma, among which 5 were intraparenchymal and 4 were subcapsular. One case (5.9%) showed active bleeding within an intrahepatic hematoma, while two cases (11.8%) had injury (laceration) of hepatic veins. There were 7 patients (41.2%) who demonstrated the so-called “halo sign” around the intrahepatic portal branches. Thirteen patients were associated with peritoneal fluid (blood) collection, 3 with hematoma or hemorrhage of the right adrenal gland, 8 with plural effusion and 3 cases with rib fractures of right lower chest. Conclusion CT imaging findings of blunt liver trauma include parenchymal laceration, intraparenchymal and /or subcapsular hematomas, active hemorrhage, and tear of hepatic veins. Plain CT scan and contrast-enhanced dual-phase acquisition is very important for the comprehensive evaluation of patients with blunt liver trauma.