Liver Trauma and Benign Causes of Hyperechoic Foci in the Liver Region

What is a hematoma?           

collection of blood     

What is the etiology of a hematoma?    

1. trauma

2. rupture of a neoplasm such as an adenoma, metastatic choriocarcinoma, or cavernous hemangioma

What are the 3 categories of liver trauma?    

1. Transcapsular laceration and rupture of the liver

2. subcapsular hematoma

3. intraparenchymal hematoma

What is the incidence of a hematoma?    

in children, blunt abdominal trauma accounts for over 90% of all abdominal injuries

What is the clinical presentation of a hematoma?    

1. pain

2. hypotension

Lab values for hematoma:    

a large hematoma may result in decreased hematocrit

Trauma occurs most often to the     

right lobe, particularly in the posterior segment

Varied appearance depending on the age of the trauma and stage of clotting:

1. acute bleeding is anechoic

2. subacute hematoma demonstrates increased echogenicity and complexity with fibrin organization

3. complete hematoma organization appears solid and isoechoic to the liver

4. increasing complexity as body lyses and absorbs hematoma

5. potentially complete resolution, calcification, or remaining anechoic cystic area may result

Intraparenchymal hematoma demonstrates     

poorly defined margins

Subcapsular hematoma demonstrates

fluid collection at border of the liver capsule with displacement of the liver parenchyma toward the porta hepatis

-demonstrate capsule integrity, hematoma collection relative to organ, and measure in 3 dimensions

Assess peritoneal potential spaces for evidence of     

hemoperitoneum

Potential concomitant biloma due to

biliary tree disruption

Calcification     

1. granulomatous change

2. healed abscess or hematoma

3. may demonstrate posterior acoustic shadowing

What happens immediately following endoscopic retrograde cholangiopancreatography (ERCP)?    

pneumobilia

What is an ERCP?    

a radiological procedure in which an endoscope is inserted into the esophagus and through the stomach into the duodenum.

-a catheter is passed through the sphincter of Oddi, and radiopaque contrast material is injected into the ampulla of Vater to opacify the biliary ducts and the pancreatic duct

-this procedure may be used for both therapeutic and diagnostic purposes

What is a sphincterotomy?

during an ERCP, the sphincter of Oddi may be cut in order to allow passage of large biliary calculi

-following this procedure air moves freely into the biliary tree

Pneumonilia also happens from:

1. emphysematous cholecystitis

2. trauma

3. duodenal ulcer perforating into the CBD

4. bouveret’s syndrome

5. causes comet-tail, ring-down artifact

6. may move with change in patient position

Foreign objects:    

a. surgical clips

b. buck shot