Liver injury after chest compressions: CT findings and diagnostic pitfalls.

OBJECTIVES: To evaluate the computed tomography (CT) findings of liver injury after chest compressions in patients who achieved return of spontaneous circulation following cardiopulmonary resuscitation. METHODS: This retrospective single-center study included consecutive patients who underwent abdominal CT after successful resuscitation (1/2006-9/2024). CT images were retrospectively reviewed to identify liver injury attributable to chest compressions. Imaging findings, injury distribution, hemorrhagic features were analyzed. RESULTS: Among 716 resuscitated patients who underwent CT, liver injury after chest compressions was identified in 11 patients (mean age, 60.5 years ± 15.8 [standard deviation]; 4 men, 7 women). All liver injuries were detected on contrast-enhanced CT (5.3%, 11/206), whereas only one liver injury was detectable on noncontrast CT (0.1%, 1/716). Lacerations predominantly involved the left lobe (64%) and caudate lobe (55%), with segment 4 being the most frequent dominant site. Right lobe involvement was uncommon. Bleeding along the falciform ligament was observed in 36% of cases. Hemoperitoneum occurred in two patients, both of whom died from hemorrhagic shock related to liver injury. CONCLUSION: Liver injury after chest compressions is an uncommon but clinically relevant complication in resuscitated patients. Contrast-enhanced CT is crucial for detection. Awareness of characteristic imaging features-including preferential involvement of the left and caudate lobes, and bleeding along the falciform ligament-can improve diagnostic recognition on post-resuscitation CT.