Hepatic subcapsular hematoma without elevated hepatic enzyme levels: A case report

In cases of abdominal trauma, elevated liver enzyme levels can indicate hepatic injury. To date, there are no documented reports of hepatic trauma without liver enzyme abnormalities. Herein, we present a case of hepatic subcapsular hematoma following a motor vehicle accident without abnormal findings in blood and biochemical tests over the course of time. The patient was a woman in her 20s who had collided with a passenger car while driving a light motor vehicle. She walked by herself to see a nearby after-hour doctor as an outpatient. Radiography was performed, and the patient was discharged on the same day. She was reexamined the next day and referred to our medical center due to possible hepatic injury. Her respiratory and circulatory dynamics were stable; however, she experienced mild tenderness in her right upper abdomen upon arrival. Echo-free space was observed in Morrison's and Douglas' pouches on abdominal ultrasound, and abdominal computed tomography showed a hepatic subcapsular hematoma (grade II according to the American Association for the Surgery of Trauma liver injury scale). However, blood and biochemical tests did not reveal any abnormalities. The hematoma reduced with conservative treatment after admission, and the patient was discharged on the 18th hospital day. This case indicates that hepatic injury cannot be ruled out based on serodiagnosis alone; thus, diagnostic imaging is required in cases of blunt abdominal trauma.