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Blunt Hepatic Trauma: Evaluation With Contrast-Enhanced Sonography

Sonographic Findings and Clinical Application

Department of Radiology, Istituto G. Pascale, Naples, Italy (O.C., M.M.R., A.S.); and Department of Radiology, Santa Maria delle Grazie Hospital, Pozzuoli, Italy (R.L.).

Address correspondence and reprint requests to Orlando Catalano, MD, Istituto G. Pascale, Via F. Crispi 92, I-80121 Naples, Italy. E-mail: orlandcat{at}tin.it

Objective. The purpose of this study was to report our initial experience in the assessment of liver trauma with real-time contrast-enhanced sonography (CES). Methods. From January 2000 to December 2003, there were 431 hemodynamically stable patients evaluated with sonography for blunt abdominal trauma. Among these patients, 87 were selected to undergo second-level imaging, consisting of CES and computed tomographic (CT) evaluation. Indications for further assessment were baseline sonographic findings positive for liver injury, baseline sonographic findings positive for injury to other abdominal parenchyma, baseline sonographic findings positive for free fluid only, baseline sonographic findings indeterminate, and baseline sonographic findings negative with persistent clinical or laboratory suspicion. Results. There were 23 hepatic lesions shown by CT in 21 patients. Peritoneal or retroperitoneal fluid was identified in 19 of 21 positive cases by all 3 imaging modalities. Liver injury was found in 15 patients on sonography and in 19 on CES. Contrast-enhanced sonography compared better than unenhanced sonography with the criterion standard for related injury conspicuity, injury size, completeness of injury extension, and involvement of the liver capsule. Both CES and CT showed intrahepatic contrast material pooling in 2 cases. All patients with false-negative sonographic or CES findings recovered uneventfully. Conclusions. Contrast-enhanced sonography is an effective tool in the evaluation of blunt hepatic trauma, being more sensitive than baseline sonography and correlating better than baseline sonography with CT findings. In institutions where sonography is regarded as the initial procedure to screen patients with trauma, this technique may increase its effectiveness. In addition, CES may be valuable in the follow-up of patients with conservatively treated liver trauma.

Key Words: computed tomography, abdominal trauma • liver trauma • sonography, contrast media • sonography, harmonic imaging

Abbreviations: CECT, contrast-enhanced computed tomography • CES, contrast-enhanced sonography • CT, computed tomography • FAST, focused assessment sonography for trauma

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