Computed Tomographic Findings of Liver Injury in Adults: Role of CT Classification on Management

PURPOSE: We studied to compare computed tomographic(CT) findings of liver injury with management methods in adults and, moreover, to present the CT basis for the management. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 43 adults diagnosed as liver injury during a 66-month period. Thirty-eight patients were hemodynamically stable. Thirty-two of them were managed conservatively, whereas six managed operatively. Five unstable patients underwent emergency operation. We classified CT findings according to the severity of liver injuries(ie, hematoma, laceration, and periportal tracking) and hemperitoneum, ranging from grade 1 to 5 and from 0 to 3+, respectively. Thus, we compared the CT classificafions with their management(ie, operation rate), especially hemodynamically stable patients. RESULTS: Operation rates of all patients and hemodynamically stable patients were 26% and 16%, respectively. Operation rate at each grade of liver injury was low, especially in hemodynamically stable, despite relatively high operation rate in grade 4. Operation rate of 3+ hemoperitoneum was 100%, including hemodynamically stable patients, in contrast to otherwise low operation rate of others. CONCLUSION: Most liver injury in adults, including grade 4, were managed conservatively, especially hemodynamically stable. Though large amount of hemoperitoneum(ie, 3+) required operation, most hemoperitoeum were managed conservatively. Thus, CT findings of liver injury is helpful in the decision for the management method.

Chronic Subdural Hematoma with Sedimentation Level on CT: Correlation with Clinical and Operative Findings

PURPOSE: The purpose of this study is to correlate CT findings of the patients with chronic subdural hematoma(SDH) showing a sedimentation level with their clinical and operative findings. MATERIALS AND METHODS: We selected 9 patients who showed a sedimentation level within the hematoma after reviewing the CT findings of 55 patients with SDH. We also analyzed their age, initial symptoms, cause of head injury, latent period, the level of consciousness on admission, CT findings, and operative findings. RESULTS: All of the 9 patients were aged persons(over 52 years). They had a history of acute exacerbation of neurologic symptoms. Five of them had an apparent history of head trauma more than one month before the exacerbation. The CT scans showed unilateral, crescent-shaped subdural fluid collection with a sedimentation level except a case of bilateral SDH and 2 cases of planoconvex-shaped SDH. The interface of the sedimentation level was sharp in 3 cases and indistinct in 6 cases. None had bleeding tendency and the hemoglobin level was slightly decreased in 2 patients. All patients revealed membrane of the hematoma during operation. The upper portion of the sedimentation was liquefied blood and the lower portion was fresh blood clots. We could observe fresh RBC's in the hematoma microscopically. CONCLUSION: A sedimentation level in chronic SDH was operatively proved to represent rebleeding, and was clinically manifested as an acute exacerbation of symptoms.