Liver injury after chest compressions: CT findings and diagnostic pitfalls

To evaluate the computed tomography (CT) findings of liver injury after chest compressions in patients who achieved return of spontaneous circulation following cardiopulmonary resuscitation.

This retrospective single-center study included consecutive patients who underwent abdominal CT after successful resuscitation (1/2006-9/2024). CT images were retrospectively reviewed to identify liver injury attributable to chest compressions. Imaging findings, injury distribution, hemorrhagic features were analyzed.

Among 716 resuscitated patients who underwent CT, liver injury after chest compressions was identified in 11 patients (mean age, 60.5 years ± 15.8 [standard deviation]; 4 men, 7 women). All liver injuries were detected on contrast-enhanced CT (5.3%, 11/206), whereas only one liver injury was detectable on noncontrast CT (0.1%, 1/716). Lacerations predominantly involved the left lobe (64%) and caudate lobe (55%), with segment 4 being the most frequent dominant site. Right lobe involvement was uncommon. Bleeding along the falciform ligament was observed in 36% of cases. Hemoperitoneum occurred in two patients, both of whom died from hemorrhagic shock related to liver injury.

Liver injury after chest compressions is an uncommon but clinically relevant complication in resuscitated patients. Contrast-enhanced CT is crucial for detection. Awareness of characteristic imaging features-including preferential involvement of the left and caudate lobes, and bleeding along the falciform ligament-can improve diagnostic recognition on post-resuscitation CT.