Abstract
Object and Methods: This study was performed to make guidelines for optimal treatment selection in patients with blunt hepatic trauma using ultrasonography (US). For this purpose, the ultrasonographic findings of hepatic parenchyma obtained at the emergency room were classified as follows: hyperechoic (Hyper) type (with diffuse homogeneous hyperechoic area), mixed (M)type (with diffuse heterogeneous area), hypoechoic local (Hypolo) type (with vague hypoechoic area), hypoechoic lacerated (Hypola) type (with hypoechoic lacerated area). In 63 patients, US findings were evaluated and clinical result such as the number of operated cases, blood pressure on admission and blood transfusion volume were analyzed. Result: There were 18 false negative cases, but none of them required specific treatment for blunt hepatic injury. There were 23 cases with Hyper type findings and 11 cases with M type, 6 cases with Hypolo type and 5 cases with hypola type. Four of 5 cases with Hypola type required massive blood transfusion (more than 1, 000ml), and 4 of 5 were hypotensive on admission. There were 3 cases with IVC injury in this group. Three of 63 patients in this study died, and all three had hypola type findings on US and IVC injury. Five cases of the M type required massive blood transfusion and were hypotensive on admission. In the M type, 6 of 11 patients underwent surgery (3 for hepatic suture, 3 for hepatic partial resection) and 2 received interventional angiography (embolization). In patients with Hyper and Hypolo types, hepatic injury was treated conservatively and no surgical treatment or embolization was required. Conclusions: A patient with blunt hepatic injury presenting hyperechoic type or hypoechoic local type findings by US on admission would not be required to undergo specific treatment for hepatic injury and would be a good candidate for conservative treatment. A patient with mixed type may require a surgical procedure or interventional angiography and further detailed imaging diagnosis would be necessary. A hypoechoic laceration pattern on US is the most serious sign of blunt hepatic injury, and there is a high incidence of IVC injury. An urgent operation should be performed when a patient has this pattern on US and shock status on admission.
