Ultrasound images Haematoma

Ultrasound images of The liver haematoma may have similar acoustic appearances to those of an abscess, but does not share the same clinical features. A haematoma is the result of trauma (usually, therefore, via the Accident and Emergency department) but the  trauma may also be iatrogenic, for example following a biopsy procedure (hence the value of using ultrasound guidance to avoid major vessels in the liver) or surgery (Fig. below).
The acoustic appearances depend upon the timing a fresh haematoma may appear liquid and echo-poor, but rapidly becomes more ‘solid’-looking
image
Image A and B,

(A) Intrahepatic haematoma following a
road traffic accident with rib fractures. The lesion is
relatively fresh and contains some low-level echoes.
(B) 2-day-old subcapsular haematoma. The collection
became progressively smaller and hyperechoic as it
resolved.
and hyperechoic, as the blood clots. As it resolves the haematoma liquefies and may contain fibrin strands. It will invariably demonstrate a band of posterior enhancement and has irregular, illdefined walls in the early stages. Later on it may encapsulate, leaving a permanent cystic ‘space’ in
the liver, and the capsule may calcify.
Injury to the more peripheral regions may cause a subcapsular haematoma which demonstrates the same acoustic properties. The haematoma outlines the surface of the liver and the capsule can be seen surrounding it. This may be the cause of a palpable ‘enlarged’ liver (Fig. B) above. Intervention is rarely necessary and monitoring with ultrasound confirms eventual resolution. More serious hepatic ruptures, however, causing haemoperitoneum, usually require surgery.
ultrasound images of Intrahepatic haematoma, ultrasound images subcapsular haematoma.
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