Hepatic Vascular Trauma—Say What?

Incidentally: In the high-stakes environs of the ED, tis easy to mistake pre-existing pathology for acute trauma. During “Selected Head-to-Toe Topics in Emergency Radiology,” co-presented with the American Society of Emergency Radiology at ARRS26, Daniela Galan, MD, pointed out a pitfall wherein a suspected hepatic vascular injury proved merely incidental. Pretty common, too.

Nuance Needed: During the evaluation of a right hepatic lobe laceration, a focus of contrast enhancement was initially flagged as a potential contained vascular injury or active hemorrhage. However, the enhancement pattern didn’t quite fit the trauma profile:

• Tell-Tales: Dr. Galan’s lesion exhibited peripheral interrupted nodular enhancement with progressive centripetal filling.
• Gestalt? Whereas active hemorrhage increases over time, this focus was too rounded to be a typical bleed.
• Eureka! Angiography confirmed the lesion was a hemangioma…not a traumatic vascular injury.

RadFYI: With DR basics forever in your own heart, do allow your head to consider alternatives—even, perhaps especially, in the middle of a trauma workup.