Classification and treatment of pooling of contrast material on computed tomographic scan of blunt hepatic trauma

Background: Pooling of contrast material on computed tomographic (CT) scan represents free extravasation of blood as a result of active bleeding. For patients with blunt hepatic injury, aggressive management such as angiograp hy or celiotomy is usually indicated if this sign is detected, The purposes of this study were to further categorize this CT scan finding and to corre late its characteristics with clinical outcomes. This CT scan classificatio n might be helpful for the selection of appropriate management. Methods: During a 42-month period, 276 patients with blunt hepatic injury w ere treated. Two hundred twelve of them were hemodynamically stable after i nitial resuscitation and underwent abdominal CT scan examination, Pooling o f contrast material was detected on the CT scans of 15 patients. The CT sca ns and medical records were reviewed, Special attention was paid to the pre sence, location, and character of the extravasated contrast material. Results: The finding of pooling of contrast material on CT scan was categor ized into three types according to its location and character. Type T showe d extravasation and pooling of contrast material in the peritoneal cavity ( six patients). All patients with type I CT scan findings became hemodynamic ally unstable soon after CT scan examination and required emergent laparoto my, Type II findings showed simultaneous presence of hemoperitoneum and int raparenchymal contrast material pooling (six patients). Four patients with type II CT scan findings required laparotomy for hemostasis. Type III findi ngs showed intraparenchymal contrast material pooling without hemoperitoneu m (three patients). Ail patients with type III CT scan signs remained hemod ynamically stable. Conclusions: With the use of a highspeed spiral CT scanner, it is possible to predict the necessity of operative management or angiography for patient s with blunt hepatic injury before deterioration of hemodynamic status. The presence of pooling of contrast material within the peritoneal cavity indi cates active and massive bleeding. Patients with this CT scan finding show rapid deterioration of hemodynamic status. Most of these patients might req uire emergent surgery, Pooling of contrast material in a ruptured hepatic p arenchyma indicates active bleeding. Close monitoring and emergent angiogra phy should be performed. Deterioration of hemodynamic status in these patie nts usually requires prompt surgical intervention. Intraparenchymal pooling of contrast material with unruptured liver capsule often indicates a self- limited hemorrhage, Patients with this CT scan finding have a high possibil ity of successful nonoperative treatment.