• Users Online: 345
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 303-305

Importance of focused assessment with sonography for trauma scan in abdominal trauma: Incidental finding of liver contusion in a case of maxillofacial injury - Ultrasonography and computed tomography imaging


Department of Radio Diagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India

Date of Submission05-Feb-2020
Date of Decision15-Feb-2020
Date of Acceptance10-Mar-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Dr. Suresh Phatak
Department of Radio Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_38_20

Rights and Permissions
  Abstract 


FAST scan is an important constituent of imaging in case of trauma. We are presenting a case of maxillofacial trauma without any external abdominal injury, in whom liver trauma was incidentally diagnosed on focused assessment with sonography for trauma scan. Ultrasonography and computed tomography features of liver trauma are discussed.

Keywords: Computed tomography scan, focused assessment with sonography for trauma scan, liver trauma, ultrasonography


How to cite this article:
Tapadia S, Phatak S, Singh V. Importance of focused assessment with sonography for trauma scan in abdominal trauma: Incidental finding of liver contusion in a case of maxillofacial injury - Ultrasonography and computed tomography imaging. J Datta Meghe Inst Med Sci Univ 2020;15:303-5

How to cite this URL:
Tapadia S, Phatak S, Singh V. Importance of focused assessment with sonography for trauma scan in abdominal trauma: Incidental finding of liver contusion in a case of maxillofacial injury - Ultrasonography and computed tomography imaging. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Jan 19];15:303-5. Available from: http://www.journaldmims.com/text.asp?2020/15/2/303/304260




  Introduction Top


In developing nations, under the age of 45 years, the major cause of death and disability is trauma.[1] Organ that is involved frequently is spleen followed by the liver.[2] Deceleration injuries cause the majority of trauma.[3] Following a history and clinical examination, a precise initial diagnostic imaging modality is needed for which ultrasonography is useful.[4] As its readily available, it requires minimal preparation time and is a mobile equipment integral to the emergency department[5] FAST technique is a rapid test that sequentially surveys the pericardial region, and then the right and left upper quadrants and pelvis.[6] Findings suggestive of positive FAST include: The presence of fluid in at least one of the three spaces – pericardial (hemopericardium), pleural (hemothorax), and peritoneal (hemoperitoneum, urine-bladder injury, bile-gall bladder injury, and bowel contents[1] computed tomography (CT) is the modality of choice for confirming findings on FAST.[7]


  Case Report Top


A 25-year-old hemodynamically stable male patient was brought to the emergency department after maxillo-facial injury. The patient was advised emergency CT scan imaging of the head which revealed multiple maxillo-facial fractures with normal brain parenchyma. The patient had no abdominal complaints and no external visible abdominal injuries. However, according to the Advanced Trauma Life Support protocol the patient was sent for focused assessment with sonography for trauma (FAST) examination-There was evidence of free fluid noted in the pelvis and Morrison's pouch with internal echo's within which suggested of hemoperitoneum [Figure 1]. On a Grey-scale ultrasound imaging, there was an ill-defined heterogeneously hyperechoic area noted in the right lobe of the liver, measuring −10.1 cm × 7 cm in size suggestive of liver contusion [Figure 2]. This was followed by a contrast-enhanced computed tomography study to confirm the sonography findings, the study revealed an ill-defined, heterogeneously hyperdense lesion with peripheral hypodensity in segment VI, VII, and VIII of the right lobe of the liver approximately measuring 10.1 cm × 7.4 cm × 5.3 cm with a HU value of 56 suggestive of liver contusion [Figure 3]a and [Figure 3]b.
Figure 1: Gray-scale ultrasound imaging showing evidence of free fluid in the pelvis with internal echo's suggestive of hemoperitoneum

Click here to view
Figure 2: Gray-scale ultrasound imaging showing an ill-defined heterogeneously hyperechoic area in the right lobe of the liver

Click here to view
Figure 3: (a) Nonenhanced computed tomography, (b) contrast-enhanced computed tomography: ill-defined, heterogeneously hyperdense lesion with peripheral hypodensity in segment VI, VII, and VIII of the right lobe of the liver having HU value of 56 s/o liver contusion

Click here to view



  Discussion Top


In abdominal blunt trauma cases, the most affected part in the liver is the right lobe as it is the most voluminous portion of the liver and posterior–superior hepatic segments as they are proximal to fixed structures such as ribs and spine which get involved in blunt trauma.[2] Ultrasonography identifies intraperitoneal collections of free fluid, a minimum of about 200 mL of fluid is required (Morrison pouch, the pouch of douglas, and splenorenal fossa). Sensitivity of FAST increases with increasing volumes of free fluid.[8]

Multi detector-row CT helps in the detection of delayed complications.[3] The American Association for the Surgery of Trauma classifies liver trauma according to the severity on CT scan imaging. Grade I-sub capsular hematoma more than 10% surface area, laceration of more than 1 cm parenchymal depth. Grade II-subcapsular hematoma 10%–50% surface area or intraparenchymal hematoma: more than 10 cm diameter or laceration of 1–3 cm parenchymal depth, more than 10 cm length. Grade III-sub capsular hematoma: More than 50% surface area of ruptured subcapsular or parenchymal hematoma or intraparenchymal hematoma: More than 10 cm or laceration of more than 3 cm parenchymal depth and vascular injury with active bleeding contained within the liver parenchyma. Grade IV-laceration: Parenchymal disruption involving 25%–75% hepatic lobe or involves 1–3 Couinaud segments or vascular injury with active bleeding breaching the liver parenchyma into the peritoneum. Grade V-laceration: Parenchymal disruption involving >75% of hepatic lobe or vascular: Juxtahepatic venous injuries (retro hepatic vena cava/central major hepatic veins). According to this classification our case was diagnosed as Grade III liver injury.[9],[10],[11],[12],[13],[14]


  Declaration of Patient Consent Top


The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


  Conclusion Top


Hence, performing FAST in a patient who has undergone trauma even without any external abdominal injuries and complaints helps us in identifying liver injuries which are confirmed on CT imaging. This helps surgeons to make rapid decisions for the management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wongwaisayawan S, Suwannanon R, Prachanukool T, Sricharoen P, Saksobhavivat N, Kaewlai R. Trauma ultrasound. Ultrasound Med Biol 2015;41:2543-61.  Back to cited text no. 1
    
2.
Romano L, Giovine S, Guidi G, Tortora G, Cinque T, Romano S. Hepatic trauma: CT findings and considerations based on our experience in emergency diagnostic imaging. Eur J Radiol 200;50:594-66.  Back to cited text no. 2
    
3.
Chatoupis K, Papadopoulou G, Kaskarelis I. New technology in the management of liver trauma. Ann Gastroenterol 2013;26:41-4.  Back to cited text no. 3
    
4.
Hapani H, Kalola J, Trivedi A, Chawla A. Ultrasound evaluation of focal hepatic lesions. J Dent Med Sci 2014;16:40-5.  Back to cited text no. 4
    
5.
Kendall JL, Faragher J, Hewitt GJ, Burcham G, Haukoos JS. Emergency department ultrasound is not a sensitive detector of solid organ injury. West J Emerg Med 2009;10:1-5.  Back to cited text no. 5
    
6.
Rozycki GS, Ballard RB, Feliciano DV, Schmidt JA, Pennington SD. Surgeon-performed ultrasound for the assessment of truncal injuries: Lessons learned from 1540 patients. Ann Surg 1998;228:557-67.  Back to cited text no. 6
    
7.
Yoon W, Jeong YY, Kim JK, Seo JJ, Lim HS, Shin SS, et al. CT in blunt liver trauma. Radiographics 2005;25:87-104.  Back to cited text no. 7
    
8.
Körner M, Krötz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current role of emergency US in patients with major trauma. Radiographics 2008;28:225-42.  Back to cited text no. 8
    
9.
Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg 2018;85:1119-22.  Back to cited text no. 9
    
10.
Kirnake V, Arora A, Sharma P, Goyal M, Chawlani R, Toshniwal J, et al. Non-Invasive Aspartate Aminotransferase to Platelet Ratio Index Correlates Well with Invasive Hepatic Venous Pressure Gradient in Cirrhosis. Indian J Gastroenterol 2018;37:335-41. Available from: https://doi.org/10.1007/s12664-018-0879-0. [Last accessed on 2019 Dec 21].  Back to cited text no. 10
    
11.
Sharma S, Singh AD, Sharma SK, Tripathi M, Das CJ, Kumar R. Gallium-68 DOTA-NOC PET/CT as an Alternate Predictor of Disease Activity in Sarcoidosis. Nucl Med Commun 2018;39:768-8. Available from: https://doi.org/10.1097/MNM.0000000000000869. [Last accessed on 2019 Dec 21].  Back to cited text no. 11
    
12.
Samad SA, Phatak SV. An Unusual Case of Abdominoscrotal Swelling in a Young Patient-Hydrocele En Bissac. J Clin Diagn Res 2018;12:83-92. Available from: https://doi.org/10.7860/JCDR/2018/37640.12278. [Last accessed on 2019 Dec 21].  Back to cited text no. 12
    
13.
Dangore-Khasbage S, Bhowate R. Utility of the Morphometry of the Maxillary Sinuses for Gender Determination by Using Computed Tomography; Dental and Medical Problems 2018;55:411-7. Available from: https://doi.org/10.17219/dmp/99622. [Last accessed on 2019 Dec 21].  Back to cited text no. 13
    
14.
Pramod RG, Agrawal A, Bhake AS, Vagha S. Correlation Study of Coagulation Profile in Spectrum of Liver Diseases. J Evol Med Dent Sci 2020;9:549-54. Available from: https://doi.org/10.14260/jemds/2020/123. [Last accessed on 2019 Dec 21].  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Declaration of P...
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed142    
    Printed12    
    Emailed0    
    PDF Downloaded17    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]