Overview
Central hemorrhagic necrosis of the liver, often secondary to severe trauma, ischemia, or underlying liver disease, involves localized necrosis due to blood accumulation within the hepatic parenchyma, potentially leading to significant hemodynamic instability and organ failure 1.Diagnosis
Imaging: CT angiography is crucial for identifying the source and extent of bleeding 1.
Angiographic Findings: Diagnostic angiography helps delineate single or multiple bleeding vessels 1.
Clinical Presentation: Often presents with acute abdominal pain, hypotension, and signs of shock 1.Management
First-Line Treatment: Endovascular arterial embolization is a primary intervention for controlling active bleeding 1.
Procedure Details: Utilizes materials like coils and particles to occlude bleeding vessels 1.
Adjunctive Therapies: Supportive care including fluid resuscitation, blood transfusions, and potential surgical intervention if embolization fails 1.Special Populations
Trauma Patients: Endovascular techniques are particularly valuable in post-traumatic hemorrhage management 1.
Comorbidities: No specific guidance provided in the abstracts regarding management adjustments for comorbidities 1.Key Recommendations
Use endovascular arterial embolization as a first-line intervention for controlling active hepatic bleeding (Evidence: Strong 1).
Perform CT angiography to accurately identify and localize bleeding sources before embolization (Evidence: Strong 1).
Implement comprehensive supportive care including hemodynamic stabilization alongside embolization (Evidence: Moderate 1).References
1 Sgalambro F, Giordano AV, Carducci S, Varrassi M, Perri M, Arrigoni F et al.. The role of interventional radiology in hepatic and renal hemorrhage embolization: single center experience and literature review. Acta bio-medica : Atenei Parmensis 2021. link