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RADIOLOGY: PANCREAS: Case# 32849: PANCREATIC AND HEPATIC LACERATIONS. This is a 62 year old female who was involved in a motor vehicle accident. There is a large hepatic laceration involving both the anterior and posterior segments of the right hepatic lobe as well as through the lateral segment of the left hepatic lobe. The laceration extends to the region of the portal veins and portal vein confluence. There is evidence of subcapsular hematoma as well as free blood around the liver. There are multiple linear areas of low attenuation in the spleen consistent with splenic laceration and contusion. There is free fluid around the spleen as well. Fluid is noted in both pericolic gutters and the cul-de-sac consistent with hemorrhage. There is an area of low attenuation between the body and head of the pancreas just anterior to the superior mesenteric vein which raises the concern of pancreatic transection. Pancreatic trauma is uncommon and associated with a high mortality since it is often occult. It is usually the result of blunt trauma, particularly child abuse. Trauma to the pancreas may cause pancreatitis, lacerations, and transections. Complete transection may be diagnosed by CT which will generally show two ends of the pancreas separated by low-density fluid that remains relatively confined to the anterior pararenal space in the immediate post-injury period. Pancreatic enlargement may also be evident. A feature common to most hepatic injury is intrahepatic hemorrhage. Hemorrhage often has a layered appearance caused by successive bleeding and clotting. Hemoperitoneum may occur in injuries extending through the capsule with bleeding or bile leakage. Other causes of intraperitoneal fluid, urine and ascites, are possible. High density fluid, however, suggests recent bleeding. Lacerations or fractures may be stellate or linear. They are defined on CT by hematoma within the area of injury. Hematomas may be isodense with unenhanced parenchyma. Large hematomas near the IVC-hepatic vein junction may indicate laceration of a major hepatic vein, and failure to recognize this may result in rapid exsanguination on laparotomy.

Peter Anderson
pancreas, radiology