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

Jen Feng Fang, Ray Jade Chen, Yon Cheong Wong, Being Chuan Lin, Yu Bau Hsu, Jung Liang Kao, Miin Fu Chen

Research output: Contribution to journalArticlepeer-review

84 Citations (Scopus)

Abstract

Background: Pooling of contrast material on computed tomograpbic (CT) scan represents free extravasation of blood as a result of active bleeding. For patients with blunt hepatic injury, aggressive management such as angiography or celiotomy is usually indicated if tiffs sign is detected. The purposes of this study were to further categorize this CT scan finding and to correlate its characteristics with clinical outcomes. This CT scan classification might be helpful for the selection of appropriate management. Methods: During a 42-month period, 276 patients with blunt hepatic injury were treated. Two hundred twelve of them were hemodynamically stable after initial resuscitation and underwent abdominal CT scan examination. Pooling of contrast material was detected on the CT scans of 15 patients. The CT scans and medical records were reviewed. Special attention was paid to the presence, location, and character of the extravasated contrast material. Results: The finding of pooling of contrast material on CT scan was categorized into three types according to its location and character. Type I showed extravasation and pooling of contrast material in the peritoneal cavity (six patients). All patients with type I CT scan findings become hemodynamically unstable soon after CT scan examination and required emergent laparotomy. Type II findings showed simultaneous presence of hemoperitoneum and intraparenchymal contrast material pooling (six patients). Four patients with type II CT scan findings required laparotomy for hemostasis. Type III findings showed intraparenchymal contrast material pooling without hemoperitoneum (three patients). All patients with type III CT scan signs remained hemodynamically stable. Conclusion: With the use of a highspeed spiral CT scanner, it is possible to predict the necessity of operative management or angiography for patients with blunt hepatic injury before deterioration of hemodynamic status. The presence of pooling of contrast material within the peritoneal cavity indicates active and massive bleeding. Patients with this CT scan finding show rapid deterioration of hemodynamic status. Most of these patients might require emergent surgery. Pooling of contrast material in a ruptured hepatic parenchyma indicates active bleeding. Close monitoring and emergent angiography should be performed. Deterioration of hemodynamic status in these patients 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 possibility of successful nonoperative treatment.

Original languageEnglish
Pages (from-to)1083-1088
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume49
Issue number6
Publication statusPublished - 2000
Externally publishedYes

Keywords

  • Blunt hepatic injury
  • Computed tomographic (CT) scan
  • Hemodynamic status
  • Pooling of contrast material

ASJC Scopus subject areas

  • Surgery

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