Advance one grade for multiple injuries up to Grade III (liver and spleen). Advance one grade for bilateral injuries up to Grade III (renal).
Liver Injury — AAST Grading
| Grade | Findings |
|---|---|
| I | Subcapsular hematoma <10% surface area; capsular laceration <1 cm depth |
| II | Subcapsular hematoma 10–50% surface area; intraparenchymal hematoma <10 cm; laceration 1–3 cm depth, <10 cm length |
| III | Subcapsular hematoma >50% or expanding; ruptured subcapsular or intraparenchymal hematoma; intraparenchymal >10 cm or expanding; laceration >3 cm depth |
| IV | Laceration with parenchymal disruption 25–75% of hepatic lobe or 1–3 Couinaud segments in a single lobe |
| V | Laceration >75% of lobe or >3 Couinaud segments; juxtahepatic venous injuries (retrohepatic IVC / central major hepatic veins) |
| VI | Hepatic avulsion |
Liver Reporting Checklist
- Lobe(s) involved; laceration depth; subcapsular / intraparenchymal hematoma size
- Active hemorrhage (arterial blush): present / absent
- Hemoperitoneum: absent / small / moderate / large
- Vascular injury: juxtahepatic IVC, central hepatic veins (Grade V); hepatic avulsion (Grade VI)
- Biloma / bile leak: suspected perihepatic collection
- AAST grade
Splenic Injury — AAST Grading
| Grade | Findings |
|---|---|
| I | Subcapsular hematoma <10% surface area; capsular laceration <1 cm depth |
| II | Subcapsular hematoma 10–50%; intraparenchymal hematoma <5 cm; laceration 1–3 cm depth, not involving trabecular vessels |
| III | Subcapsular hematoma >50% or expanding; ruptured subcapsular or intraparenchymal hematoma ≥5 cm or expanding; laceration >3 cm depth or involving trabecular vessels |
| IV | Laceration involving segmental or hilar vessels → major devascularization (>25% of spleen) |
| V | Completely shattered spleen; hilar vascular injury devascularizing the spleen |
Splenic Reporting Checklist
- Laceration depth; subcapsular / intraparenchymal hematoma size
- Splenic vascular injury: pseudoaneurysm / active extravasation
- Perisplenic hematoma; hemoperitoneum volume
- AAST grade
Renal Injury — AAST Grading
| Grade | Findings |
|---|---|
| I | Contusion (microscopic/gross hematuria, normal urologic studies) or nonexpanding subcapsular hematoma; no parenchymal laceration |
| II | Nonexpanding perirenal hematoma; laceration <1.0 cm cortical depth — no collecting system rupture |
| III | Laceration >1.0 cm cortical depth — no collecting system rupture |
| IV | Laceration through cortex, medulla, and collecting system; main renal artery or vein injury with contained hemorrhage |
| V | Shattered kidney; hilar avulsion devascularizing the kidney |
Advance one grade for bilateral renal injuries up to Grade III.
Renal Reporting Checklist
- Side(s); laceration depth; perirenal hematoma
- Collecting system: intact vs. urinary extravasation
- Active hemorrhage: present / absent
- Renal vasculature: intact / hilar injury / devascularization
- AAST grade
Pancreatic Injury — AAST Grading
Advance one grade for multiple pancreatic injuries up to Grade III. Proximal pancreas = to the patient's right of the superior mesenteric vein.
| Grade | Findings |
|---|---|
| I | Minor contusion or superficial laceration — no duct injury |
| II | Major contusion or laceration — no duct injury, no tissue loss |
| III | Distal transection or parenchymal injury with duct injury |
| IV | Proximal transection or parenchymal injury involving the ampulla |
| V | Massive disruption of the pancreatic head |
Key CT signs: peripancreatic fluid / stranding · parenchymal laceration (low-attenuation line) · ductal injury suggested by complete transection or peripancreatic fluid tracking along duct · MRCP or ERCP for definitive duct assessment. Grade III–V injuries typically require surgery or endoscopic intervention.
Pancreatic Reporting Checklist
- Location: head / neck / body / tail
- Main pancreatic duct: intact / probable disruption / transection
- Peripancreatic fluid / stranding: absent / present
- Active hemorrhage: present / absent
- AAST grade; recommend MRCP or ERCP if Grade III+ suspected
References
Radiopaedia — Pancreatic trauma