The ACR Appropriateness Criteria recommend CT as the initial imaging test of choice for patients presenting with right lower quadrant pain ( Table 3). Ultrasonography may be considered if CT is unavailable ultrasonography may help detect obstruction but has poor sensitivity for visualizing stonesĬT of abdomen and pelvis with contrast media 12Ĭonventional radiography may be appropriate for initial evaluationĪcute appendicitis is the most common cause of right lower quadrant pain requiring surgery 5 and is the focus of imaging considerations in this location. Ultrasonography of pelvis (transvaginal and transabdominal) 9ĬT angiography of abdomen with contrast media 10Ĭonventional angiography is invasive but may be considered to diagnose and treat with a single procedureĬT of abdomen and pelvis without contrast media 11 Patients with typical symptoms and no suspected complications may not require imaging Magnetic resonance imaging is another emerging technique for the evaluation of abdominal pain that avoids ionizing radiation.ĬT of abdomen and pelvis with contrast media 3Ĭonsider CT if ultrasonography is nondiagnostic, presentation is atypical, or patient is critically illĬT of abdomen and pelvis with contrast media 5Ĭholescintigraphy or CT may be considered if ultrasonography is equivocalĬhoice of examination depends on institutional preferences and resourcesĬT of abdomen and pelvis with contrast media 8 Strategies to reduce exposure are currently being studied, such as using ultrasonography as an initial study for suspected appendicitis before obtaining CT and using low-dose CT rather than standard-dose CT. The widespread use of CT raises concerns about patient exposure to ionizing radiation. Conventional radiography has limited diagnostic value in the assessment of most patients with abdominal pain. Computed tomography (CT) is recommended for evaluating right or left lower quadrant pain. Ultrasonography is the initial imaging test of choice for patients presenting with right upper quadrant pain. The American College of Radiology has developed clinical guidelines, the Appropriateness Criteria, based on the location of abdominal pain to help physicians choose the most appropriate imaging study. If the patient history, physical examination, and laboratory testing do not identify an underlying cause of pain and if serious pathology remains a clinical concern, diagnostic imaging is indicated. Acute abdominal pain is a common presentation in the outpatient setting and can represent conditions ranging from benign to life-threatening.
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