Blunt liver trauma in children: the role of computed tomography in diagnosis and treatment.

In a retrospective evaluation of 12 children with blunt liver trauma studied by computed tomography (CT), all patients studied preoperatively had subcapsular hematomas (6/6). Eleven of twelve patients had parenchymal lesions that were located predominantly in the superior subsegments of the right lobe: 9/12 posteriorly (segment no. 7) and 7/12 anteriorly (segment no. 8) where transections were most frequent. Lacerations were accompanied by intraparenchymal hematomas. Intravenous bolus contrast enhancement visualizes segmental anatomy and is absolutely necessary in order to map lacerations, recognize nonviable tissue, and relate them to major vessels. Except in critically unstable patients, noninvasive imaging of hepatic and other combined abdominal lesions can avoid diagnostic laparotomy or justify planning of a tailored, maybe less radical surgical procedure. Complications, such as abscess formation, can be demonstrated and drained percutaneously. Despite cost, CT is currently the single best imaging method in acute liver trauma.