UVM Radiology

Liver Lacerations AAST Criteria and Examples


Trauma to the liver may result in subcapsular or intrahepatic hematoma, contusion, vascular injury, or biliary disruption. CT scanning, particularly contrast-

enhanced CT scanning (CECT), is accurate in localizing the focus and extent of hepatic injuries and associated trauma, providing vital information for treatment in patients. CT scanning without intravenous contrast enhancement is of limited value in hepatic trauma, but it can be useful in identifying or following up a hemoperitoneum.

CT scan criteria for staging liver trauma based on the AAST liver injury scale include the following:

  • Grade 1 - Subcapsular hematoma less than 1 cm in maximal thickness, capsular avulsion, superficial parenchymal laceration less than 1 cm deep, and isolated periportal blood tracking
  • Grade 2 - Parenchymal laceration 1-3 cm deep and parenchymal/subcapsular hematomas 1-3 cm thick
  • Grade 3 - Parenchymal laceration more than 3 cm deep and parenchymal or subcapsular hematoma more than 3 cm in diameter
  • Grade 4 - Parenchymal/subcapsular hematoma more than 10 cm in diameter, lobar destruction, or devascularization
  • Grade 5 - Global destruction or devascularization of the liver
  • Grade 6 - Hepatic avulsion

Adapted from:

J Trauma. 1995 Mar;38(3):323-4. Organ injury scaling: spleen and liver (1994 revision). Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR.
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