Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury

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

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

BACKGROUND: Nonoperative management of blunt hepatic injury is currently a widely accepted treatment modality. Computed tomography (CT) is an important imaging study both for diagnosis and follow-up of these patients. There is, however, no reliable predictor of failure of nonoperative treatment other than the ultimate development of hemodynamic instability. Previous reports mostly were based on the data obtained from low-speed dynamic incremental scanners. The purpose of this study is to evaluate the value of a high-speed helical scanner in predicting the outcome of patients managed nonoperatively. METHODS: During a 30-month period, 194 patients with blunt hepatic injury were treated, 150 of them were hemodynamically stable after initial resuscitation and underwent abdominal CT examination. All CT scans were performed with the High Speed Advantage Scanner. The CT scans and medical records were reviewed. RESULTS: Nonoperative management was successfully applied to all patients with grade I and II, 93% of grade III, 87% of grade IV, and 67% of grade V liver injuries. Twelve patients required liver-related celiotomy. Pooling of contrast material was detected on the CT scans of 8 patients. Six (75%) of these patients developed hemodynamic instability and required liver-related celiotomy later. Pooling of contrast material can be detected in 50% of the patients receiving liver-related celiotomy. CONCLUSION: The presence of pooling of contrast material within the hepatic parenchyma indicates free extravasation of blood as a result of active bleeding. In patients with blunt hepatic injury, if this sign is detected, nonoperative treatment should be terminated and angiography or celiotomy undertaken promptly. With the increasing use of high-speed spiral CT scanner and improvement in scanning technique, pooling of contrast material may become a sensitive sign for active bleeding and may be used as a guide for the selection of treatment modality.

Original languageEnglish
Pages (from-to)315-319
Number of pages5
JournalAmerican Journal of Surgery
Volume176
Issue number4
DOIs
Publication statusPublished - Oct 1998
Externally publishedYes

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Nonpenetrating Wounds
Contrast Media
Tomography
Liver
Hemodynamics
Hemorrhage
Spiral Computed Tomography
Treatment Failure
Resuscitation
Medical Records
Angiography
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury. / Fang, Jen Feng; Chen, Ray Jade; Wong, Yon Cheong; Lin, Being Chuan; Hsu, Yu Bau; Kao, Jung Liang; Kao, Yi Chin.

In: American Journal of Surgery, Vol. 176, No. 4, 10.1998, p. 315-319.

Research output: Contribution to journalArticle

Fang, Jen Feng ; Chen, Ray Jade ; Wong, Yon Cheong ; Lin, Being Chuan ; Hsu, Yu Bau ; Kao, Jung Liang ; Kao, Yi Chin. / Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury. In: American Journal of Surgery. 1998 ; Vol. 176, No. 4. pp. 315-319.
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abstract = "BACKGROUND: Nonoperative management of blunt hepatic injury is currently a widely accepted treatment modality. Computed tomography (CT) is an important imaging study both for diagnosis and follow-up of these patients. There is, however, no reliable predictor of failure of nonoperative treatment other than the ultimate development of hemodynamic instability. Previous reports mostly were based on the data obtained from low-speed dynamic incremental scanners. The purpose of this study is to evaluate the value of a high-speed helical scanner in predicting the outcome of patients managed nonoperatively. METHODS: During a 30-month period, 194 patients with blunt hepatic injury were treated, 150 of them were hemodynamically stable after initial resuscitation and underwent abdominal CT examination. All CT scans were performed with the High Speed Advantage Scanner. The CT scans and medical records were reviewed. RESULTS: Nonoperative management was successfully applied to all patients with grade I and II, 93{\%} of grade III, 87{\%} of grade IV, and 67{\%} of grade V liver injuries. Twelve patients required liver-related celiotomy. Pooling of contrast material was detected on the CT scans of 8 patients. Six (75{\%}) of these patients developed hemodynamic instability and required liver-related celiotomy later. Pooling of contrast material can be detected in 50{\%} of the patients receiving liver-related celiotomy. CONCLUSION: The presence of pooling of contrast material within the hepatic parenchyma indicates free extravasation of blood as a result of active bleeding. In patients with blunt hepatic injury, if this sign is detected, nonoperative treatment should be terminated and angiography or celiotomy undertaken promptly. With the increasing use of high-speed spiral CT scanner and improvement in scanning technique, pooling of contrast material may become a sensitive sign for active bleeding and may be used as a guide for the selection of treatment modality.",
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AU - Kao, Yi Chin

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