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Hepatic injury from blunt trauma in children: follow-up evaluation with CT
D I Bulas1, M R Eichelberger, C J Sivit
1Department of Diagnostic Imaging and Radiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC 20010.
Insights
Children with mild to moderate hepatic injuries heal quickly after blunt abdominal trauma. Severe injuries take months to resolve, necessitating follow-up CT scans to confirm healing and prevent complications.
Area of Science:
- Pediatric Traumatology
- Abdominal Imaging
- Hepatic Injury Management
Background:
- Computed tomography (CT) is crucial for assessing blunt abdominal trauma in children.
- Nonsurgical management is increasingly common for pediatric hepatic injuries.
Purpose of the Study:
- To utilize a CT grading system to evaluate healing timelines and complication rates in pediatric hepatic injuries.
- To correlate CT findings with clinical outcomes and recovery periods.
Main Methods:
- Forty-five children with CT-diagnosed hepatic injury underwent clinical follow-up and serial CT scans.
- Injuries were graded as mild (<25% lobe), moderate (25-50% lobe), or severe (>50% lobe).
Main Results:
- Mild injuries healed within 1 week to 11 months.
- Moderate injuries showed complete healing in 67% by 1-3 months and 80% by 3.5-6 months.
- Severe injuries exhibited residual lesions up to 8-15 months post-trauma, with no delayed complications.
Conclusions:
- CT grading effectively estimates healing duration for pediatric hepatic injuries.
- Mild and moderate injuries resolve relatively quickly.
- Severe injuries require extended follow-up CT scans (9+ months) to confirm resolution.
Objective:
Because CT is now used to assess the extent of abdominal injury after blunt trauma, children with hepatic injury often can be treated nonsurgically. We used a CT grading system to evaluate the frequency of complications and the time course of healing in children with hepatic injury from blunt abdominal trauma.
Materials And Methods:
Forty-five children with CT or surgical evidence of hepatic injury after blunt abdominal trauma were followed up clinically and with serial CT scans. Hepatic injuries were graded as mild (< 25% of one lobe injured), moderate (25-50% of one lobe injured), or severe (> 50% of one lobe injured). Physical activities were limited until healing was verified with follow-up CT scans.
Results:
All mild hepatic injuries (n = 12) appeared to have healed on follow-up CT studies 1 week to 11 months after the injury. Sixty-seven percent of moderate hepatic injuries (n = 19) showed complete healing on CT scans 1-3 months after injury, and 80% showed complete healing between 3.5 and 6 months. In all 14 children with severe hepatic injuries, residual lesions were seen on CT scans up to 8 months after injury. Residual lesions were seen in seven of 11 children with severe injuries who were reexamined 9-15 months after trauma. Despite this protracted course, no delayed hepatic complications occurred. No difference was seen between unenhanced and IV contrast-enhanced CT findings in 28 of 32 studies. IV contrast material improved the resolution of residual lesions in two cases, and two residual lesions were identified only on unenhanced CT scans.
Conclusion:
CT grading of acute hepatic injuries is useful for estimating the time course of healing. Although mild and moderate hepatic injuries heal relatively quickly, severe hepatic injuries take months to resolve. Follow-up CT scans to verify complete hepatic healing should be obtained 3 months after mild injuries, 3-6 months after moderate injuries, and 9 months after severe injuries.