Long‐Term Chronological Changes of Liver Stiffness After Hepatic Rupture: A Case Report

Background Shear wave elastography (SWE) was originally developed to assess the staging of fibrosis caused by chronic liver diseases, including chronic hepatitis B and C and metabolic dysfunction‐associated steatotic liver disease. However, it has not been previously used to evaluate traumatic liver injury. Case Presentation A 19‐year‐old seemingly healthy male was transferred to our emergency department due to multiple injuries caused by a motor vehicle accident. He was in shock due to hemothorax and a ruptured liver. He was treated with a massive blood transfusion followed by chest drainage, open abdominal surgery, and transcatheter arterial embolization (TAE). After closing the abdominal wounds, a series of abdominal ultrasounds including SWE were conducted on the unaffected lobe (Segment 5) adjacent to the destructed lobes (mainly Segments 7 and 8). On Day 48 of hospitalization, his abdominal ultrasound, using color Doppler, showed hepatofugal portal vein flow showing arterioportal shunts, which were embolized by another TAE. The portal vein flow then became hepatopetal on Day 80, indicating a successful embolization. After Day 70, the amount of ascites drastically decreased, and the liver enzymes, including aspartate aminotransferase (AST), alanine transaminase (ALT), and bilirubin, decreased gradually. However, the SWE values plateaued (above 1.8 m/s) during the follow‐up period (380 days after injury) despite normalization of the liver markers, Type IV collagen, and hyaluronic acid. Conclusion This case represents the first report of long‐term SWE findings following severe liver trauma. The observation of persistently elevated SWE values in unaffected parenchyma for more than 1 year raises important questions regarding post‐traumatic hepatic remodeling; however, further studies are needed to clarify the significance of these findings and the potential role of SWE in traumatic liver injury.