AAST liver injury scale
Updates to Article Attributes
The AAST (American Association for the Surgery of Trauma) liver injury scale, most recently revised in 2018, is is the most widely used liver injury grading system 3.
The 2018 update incorporates "vascular injury" (i.e. pseudoaneurysm, arteriovenous fistula) into the imaging criteria for visceral injury 3.
Classification
-
grade I
haematoma: subcapsular, <10% surface area
laceration: capsular tear, <1 cm
parenchymalparenchymal depth
-
grade II
haematoma: subcapsular, 10-50% surface area
haematoma: intraparenchymal <10 cm diameter
laceration: capsular tear 1-3 cm parenchymal depth, <10 cm length
-
grade III
haematoma: subcapsular, >50% surface area
of ruptured subcapsular or parenchymal haematomahaematoma: intraparenchymal >10 cm
laceration: capsular tear >3 cm parenchymal depth
ruptured subcapsular or parenchymal haematoma
vascular injury with active bleeding contained within liver parenchyma
-
grade IV
laceration: parenchymal disruption involving 25-75% of a hepatic lobe or involves 1-3 Couinaud segments
vascular injury with active bleeding breaching the liver parenchyma into the peritoneum
-
grade V
laceration: parenchymal disruption involving >75% of hepatic lobe
vascular: juxtahepatic venous injuries (retrohepatic vena cava / central major hepatic veins)
Additional points
advance one grade for multiple injuries up to grade III
for each grade, the worst feature is chosen, either haematoma or laceration (no need for both/all to coexist)
"vascular injury" (i.e. pseudoaneurysm or AV fistula):
appearsappears as a focal collection of vascular contrast which decreases in attenuation on delayed images"active bleeding":
focalfocal or diffuse collection of vascular contrast which increases in size or attenuation on a delayed phase
Imaging technique
The AAST guidelines recommend dual arterial/portal venous phase imaging for evaluation of a vascular injury of liver, spleen, or kidney 3.
-<p>The <strong>AAST (American Association for the Surgery of Trauma) liver injury scale</strong>, most recently revised in 2018, is the most widely used <a href="/articles/liver-trauma">liver injury</a> grading system <sup>3</sup>.</p><p>The 2018 update incorporates "vascular injury" (i.e. <a href="/articles/false-aneurysm">pseudoaneurysm</a>, <a href="/articles/arteriovenous-fistula">arteriovenous fistula</a>) into the imaging criteria for visceral injury <sup>3</sup>.</p><h4>Classification</h4><ul>- +<p>The <strong>AAST (American Association for the Surgery of Trauma) liver injury scale</strong>, most recently revised in 2018, is the most widely used <a href="/articles/liver-trauma">liver injury</a> grading system <sup>3</sup>.</p><p>The 2018 update incorporates "vascular injury" (i.e. <a href="/articles/false-aneurysm">pseudoaneurysm</a>, <a href="/articles/arteriovenous-fistula">arteriovenous fistula</a>) into the imaging criteria for visceral injury <sup>3</sup>.</p><h4>Classification</h4><ul>
-<li><p>laceration: capsular tear, <1 cm parenchymal depth</p></li>- +<li><p>laceration: capsular tear, <1 cm parenchymal depth</p></li>
-<li><p>haematoma: subcapsular, >50% surface area of ruptured subcapsular or parenchymal haematoma</p></li>- +<li><p>haematoma: subcapsular, >50% surface area </p></li>
- +<li><p>ruptured subcapsular or parenchymal haematoma</p></li>
-<li><p>laceration: parenchymal disruption involving 25-75% of a hepatic lobe or involves 1-3 <a href="/articles/couinaud-classification-of-hepatic-segments">Couinaud segments</a> </p></li>- +<li><p>laceration: parenchymal disruption involving 25-75% of a hepatic lobe or involves 1-3 <a href="/articles/couinaud-classification-of-hepatic-segments">Couinaud segments</a> </p></li>
-<li><p>"vascular injury" (i.e. <a href="/articles/false-aneurysm" title="Pseudoaneurysm">pseudoaneurysm</a> or <a href="/articles/arteriovenous-fistula" title="Arteriovenous fistula">AV fistula</a>): appears as a focal collection of vascular contrast which decreases in attenuation on delayed images</p></li>-<li><p>"active bleeding": focal or diffuse collection of vascular contrast which increases in size or attenuation on a delayed phase</p></li>- +<li><p>"vascular injury" (i.e. <a href="/articles/false-aneurysm" title="Pseudoaneurysm">pseudoaneurysm</a> or <a href="/articles/arteriovenous-fistula" title="Arteriovenous fistula">AV fistula</a>): appears as a focal collection of vascular contrast which decreases in attenuation on delayed images</p></li>
- +<li><p>"active bleeding": focal or diffuse collection of vascular contrast which increases in size or attenuation on a delayed phase</p></li>
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