Computed tomography, angiography, and endoscopic retrograde cholangiopancreatography in the nonoperative management of hepatic and splenic trauma. CT criteria for management of blunt liver trauma: correlation with angiographic and surgical findings. 19 Poletti PA, Mirvis SE, Shanmuganathan K, Killeen KL, Coldwell D.Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. CT scan evaluation of blunt hepatic trauma. Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention).

Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries.

15 Carrillo EH, Spain DA, Wohltmann CD, et al.

Nonsurgical management of patients with blunt hepatic injury: efficacy of transcatheter arterial embolization.

14 Hagiwara A, Yukioka T, Ohta S, et al.

Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients.

13 Pachter HL, Knudson MM, Esrig B, et al.

The current status of nonoperative management of adult blunt hepatic injuries. Current status of nonoperative management of liver injuries. Factors of failure for nonoperative management of blunt liver and splenic injuries. Selection of nonoperative management candidates. High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ.

8 Velmahos GC, Toutouzas K, Randall R, et al.

Associated injuries in blunt solid organ trauma: implications for missed injury in nonoperative management.

7 Miller PR, Croce MA, Bee TK, Malhotra AK, Fabian TC.

Evolution in the management of hepatic trauma: a 25-year perspective. 6 David Richardson J, Franklin GA, Lukan JK, et al.Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. 4 Malhotra AK, Fabian TC, Croce MA, et al.Significant trends in the treatment of hepatic trauma: experience with 411 injuries. 3 Pachter HL, Spencer FC, Hofstetter SR, Liang HG, Coppa GF.Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients: results of a prospective trial. 2 Croce MA, Fabian TC, Menke PG, et al.Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole-body helical computed tomography. 1 Matthes G, Stengel D, Seifert J, et al.Follow-up CT is needed in patients with high-grade liver injuries to identify potential complications that require early intervention. CT is also useful in the assessment of delayed complications in blunt liver trauma, including delayed hemorrhage, hepatic or perihepatic abscess, posttraumatic pseudoaneurysm and hemobilia, and biliary complications such as biloma and bile peritonitis. It is important that radiologists be familiar with the liver injury grading system based on these CT features that was established by the American Association for the Surgery of Trauma. The CT features of blunt liver trauma include lacerations, subcapsular or parenchymal hematomas, active hemorrhage, juxtahepatic venous injuries, periportal low attenuation, and a flat inferior vena cava. CT is the diagnostic modality of choice for the evaluation of blunt liver trauma in hemodynamically stable patients and can accurately help identify hepatic parenchymal injuries, help quantify the degree of hemoperitoneum, and reveal associated injuries in other abdominal organs, retroperitoneal structures, and the gastrointestinal tract.

The use of helical computed tomography (CT) in the diagnosis and management of blunt liver trauma is mainly responsible for the notable shift during the past decade from routine surgical to nonsurgical management of blunt liver injuries. Nonsurgical treatment has become the standard of care in hemodynamically stable patients with blunt liver trauma.

Blunt trauma