Data on 306 liver injuries were collected prospectively during a 10-year period. Of the 306 injuries, 281 were the result of blunt trauma. Major hepatic venous injuries were encountered in 41 of 306 patients (13%). Blunt trauma was responsible for 39 of the 41 venous injuries. Twenty-five (61%) of these patients died compared with an overall mortality rate of 31% (chi 2; p less than 0.001). Twenty-two of the 25 deaths were caused by blood loss. Two patterns of hepatic venous injury appeared to predominate: avulsion of the trunk of the right hepatic vein from the inferior vena cava and avulsion of the upper branch of the right hepatic vein. The trunk injury was seen in 15 patients, 12 of whom died. The branch injury was seen in 13 patients, only 4 of whom died (Fisher's exact test; p = 0.006). In what appears to be the largest series of blunt hepatic venous injuries published, the injuries have been classified according to the anatomic site of the injury. Such a classification correlates with prognosis. Differences between blunt and penetrating hepatic venous trauma have been discussed.