BLUNT HEPATIC-TRAUMA IN ADULTS - CORRELATION OF CT INJURY GRADING WITH OUTCOME

PURPOSE: To correlate injury grading with computed tomography (CT) to treatment outcome. MATERIALS AND METHODS: Forty-eight patients with pr oved blunt hepatic injuries underwent dynamic CT with contrast materia l before treatment. The injuries were classified with a five-point CT- based grading system. The CT injury grades and the amount of hemoperit oneum seen on CT scans were compared with the clinical and surgical fi ndings, radiologic follow-up, and outcome. RESULTS: Hepatic injuries w ere classified as CT grade 1 in two patients, grade 2 in 15 patients, grade 3 in 21 patients, and grade 4 in 10 patients. Conservative treat ment was performed in 38 patients, including 15 patients with grade 3 and 10 patients with grade 4 injuries; 10 of these patients also had m ajor hemoperitoneum (>500 mL). Conservative treatment was successful i n 37 patients but was complicated in two patients by development of an arteriovenous fistula or a biloma and failed in one patient because o f delayed hepatic rupture. Exploratory laparotomy was performed in 10 patients but revealed marked active hepatic bleeding in only one patie nt. CONCLUSION: Injury grading with CT may reflect the degree of hepat ic parenchymal damage but does not indicate patients in whom complicat ions may develop or surgery is necessary. Monitoring of conservative t reatment with CT allows detection of resultant complications.