Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 68

a b c Figure. (a, b) Axial contrast-enhanced CT images show ill-defined hepatic hypodensities predominantly located within the right hepatic lobe (arrow). Notice the appearance of a gallstone (arrowhead). (c) A coronal image shows ill-defined hepatic parenchyma hematomas predominantly within the right hepatic lobe (arrow). be solitary or multiple and sometimes can be associated with hepatic enlargement and edema. Contrast-enhanced CT examination may be preferable in the unstable patient if fast multislice technology can be employed, given its rapidity and increased sensitivity and specificity. On contrast-enhanced examination, hematoma and/or hemorrhage will appear as single or multiple ill-defined or sometimes wedgeshaped regions of hypoattenuation. Hemorrhage tends to be located near the portal triads, while hematomas can arise from anywhere in the parenchyma. As in ultrasound, pericapsular hemorrhage can occur and appears as a crescent-shaped fluid density, usually hypoattenuating to adjacent normally perfused hepatic parenchyma. An advantage of contrast-enhanced CT is its ability to evaluate active extravasation of intravascular contrast, suggesting active hemorrhage. If contrast is seen outside a vessel and appears the same density as the intravascular contrast, 142 the source of hemorrhage may be arterial in origin, and close observation or potentially catheter-directed arterial embolization might be needed for treatment. As the speed and accuracy of CT examination improves with the employment of new low-dose techniques, clinicians are becoming more inclined to employ CT imaging in the diagnosis of patients with these perinatal complications. It is imperative that radiologists be aware of the characteristics and potential lethality of HELLP syndrome and other perinatal complications to ensure correct and timely treatment. 1. 2. Nunes JO, Turner MA, Fulcher AS. Abdominal imaging features of HELLP syndrome: a 10-year retrospective review. AJR Am J Roentgenol 2005;185(5):1205–1210. Padden MO. HELLP syndrome: recognition and perinatal management. Am Fam Physician 1999;60(3):829–836, 839. Baylor University Medical Center Proceedings Volume 27, Number 2