Liver laceration

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Abdominal pain after fall.

CT shows:

  • Subcapsular hemorrhage of liver
  • Intraparenchymal hemorrhage
  • Involvement of segment 4a and 4b


Why is Courinaud segment important?

American Association for the Surgery of Trauma (AAST) system (based on CT findings)
– Grade I-III:  Conservative management, better prognosis than higher grades
– Grade IV-VI: Endovascular intervention (embolization) or surgery usually required, worse prognosis


The key is whether this is

  • a capsular tear (superficial): Grade I-III or
  • intraparenchymal rupture (deep) with involvement of >1 segments or hepatic lobes: Grade IV and later



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