From the Guidelines
A liver lesion discovered after a motor vehicle accident (MVA) should be evaluated with a CT scan with intravenous contrast, which is the gold standard in hemodynamically stable trauma patients 1. The diagnostic approach to a liver lesion after an MVA should prioritize the patient's hemodynamic status, as this guides the choice of imaging and subsequent management.
- In hemodynamically stable patients, a CT scan with intravenous contrast is recommended to characterize the lesion and assess for any associated injuries 1.
- The use of E-FAST is also supported as a rapid method for detecting intra-abdominal free fluid, which can indicate the need for further evaluation or intervention 1.
- For patients being considered for non-operative management (NOM), a CT scan with intravenous contrast should always be performed to assess the extent of the injury and guide management decisions 1.
- Angiography/angioembolization (AG/AE) may be considered as a first-line intervention in hemodynamically stable patients with arterial blush on CT scan, highlighting the importance of early vascular evaluation in the management of liver trauma 1. Key considerations in the workup of a liver lesion after an MVA include:
- The patient's hemodynamic status, which dictates the urgency and approach to imaging and management
- The use of CT scan with intravenous contrast as the gold standard for evaluating liver injuries in stable patients
- The potential role of AG/AE in managing arterial bleeding or other vascular complications
- The importance of a multidisciplinary approach, involving specialists such as hepatologists, surgeons, and interventional radiologists, in the management of complex liver injuries or lesions with concerning features.
From the Research
Lesion on the Liver Workup after an MVA
- The workup for a lesion on the liver after a motor vehicle accident (MVA) may involve various imaging techniques, including CT scans and MRI, to characterize the lesion and determine the extent of the injury 2, 3, 4.
- The use of contrast material in CT scans can help improve the detection and diagnosis of liver abnormalities, particularly neoplastic disease 3.
- In cases where the findings on CT and MRI are indeterminate, contrast-enhanced ultrasound (CEUS) may be used as a problem-solving tool to further evaluate the lesion 5.
- The management of incidental liver lesions on CT scans is guided by recommendations from the ACR Incidental Findings Committee, which provides an algorithm for categorizing liver lesions based on patient characteristics and imaging features 6.
- The algorithm addresses most, but not all, pathologies and clinical scenarios, and its goal is to improve the quality of care by providing guidance on how to manage incidentally detected liver lesions 6.
Imaging Techniques
- CT scans are commonly used to evaluate liver lesions, and the use of contrast material can help improve the detection and diagnosis of liver abnormalities 3.
- MRI may also be used to characterize liver lesions, particularly in cases where the findings on CT scans are indeterminate 5.
- CEUS is a useful tool for evaluating liver lesions that are indeterminate on CT and MRI, and can help establish a confident diagnosis and determine the need for further invasive diagnosis or treatment 5.
Clinical Considerations
- The presence of a liver lesion after an MVA may be associated with other injuries, such as thoracic injuries, and the clinical evaluation should take into account the overall injury pattern 2, 4.
- The management of liver lesions should be guided by the patient's clinical presentation, imaging findings, and other relevant factors, such as the presence of other injuries or underlying medical conditions 6.