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,

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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