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Contrast-Enhanced Sonographic Guidance for Local Injection of a Hemostatic Agent for Management of Blunt Hepatic Hemorrhage: A Canine Study

Jie Tang1, Faqin Lv1, Wenxiu Li1, Huiqin Zhang1, Yukun Luo1, Lichun An1 and Tanshi Li2

1 Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Rd., Beijing 100853, China.
2 Intensive Care Unit, Chinese People's Liberation Army General Hospital, Beijing, China.


Figure 1
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  		Fig. 1 —Diagram shows construction plan of impacting device, which consists of supporter, impacting handle, piston handle, power bullet, and powder-actuated fastening tool. Device can produce 300 N–5.7 kN of force to induce trauma to abdominal organs of rabbits, dogs, and swine. Reprinted with permission from [16] Li Z, Dong XZ, You FS, et al. Establishment of animal model of intraperitoneal bleeding in rabbits. Chin J Comp Med 2006; 16:217–219.

 

Figure 2
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  		Fig. 2A —2-year-old 18-kg female dog immediately after impact on liver. CT scan confirms presence of liver injury (thick arrows) and perihepatic free liquid (thin arrows).

 

Figure 3
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  		Fig. 2B —2-year-old 18-kg female dog immediately after impact on liver. Contrast-enhanced sonographic image shows hypoechoic and anechoic perfusion defects in injury region (thick arrows) and broken hepatic capsule (thin arrow).

 

Figure 4
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  		Fig. 3 —2-year-old 19-kg female dog with active hemorrhage due to liver injury. Real-time contrast-enhanced sonographic image shows liver injury site as anechoic perfusion defect (thick arrows). Hyperechoic contrast pooling (thin arrow) indicates active hemorrhage.

 

Figure 5
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  		Fig. 4A —2-year-old 19-kg female dog after hepatic trauma. Real-time contrast-enhanced sonographic images show focal injection of hemostatic agents. Puncture needle is inserted precisely in sequence into injury site (thick arrows, A) with contrast pulse sequencing guidance and into bleeding site (thick arrow, B) with microvascular density guidance. Injection needle (thin arrows) is hyperechoic.

 

Figure 6
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  		Fig. 4B —2-year-old 19-kg female dog after hepatic trauma. Real-time contrast-enhanced sonographic images show focal injection of hemostatic agents. Puncture needle is inserted precisely in sequence into injury site (thick arrows, A) with contrast pulse sequencing guidance and into bleeding site (thick arrow, B) with microvascular density guidance. Injection needle (thin arrows) is hyperechoic.

 

Figure 7
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  		Fig. 5A —3-year-old 18-kg male dog after injection for management of hepatic trauma. Photograph of gross specimen shows injury site covered by clots and glue membrane (arrows).

 

Figure 8
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  		Fig. 5B —3-year-old 18-kg male dog after injection for management of hepatic trauma. Histopathologic photograph shows adhesive glue covering and cohering wound, partial embolization of microvessels (arrows), and inflammatory cell infiltration between hepatocytes. (x100)

 

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