Evaluation of acute right upper quadrant pain: sonography and 99mTc-PIPIDA cholescintigraphy

Shuman, W P; Mack, L A; Rudd, Thomas G.; Rogers, J V; Gibbs, Paul

doi:10.2214/ajr.139.1.61

Cited by 45 publications

(4 citation statements)

References 18 publications

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“…The accuracy of hepatobiliary scintigraphy for the detection of acute cholecystitis has been examined in many studies; in the largest of these, sensitivity and specificity of 98% and 100%, respectively, were found (3). In subsequent studies, the accuracy of hepatobiliary scintigraphy was compared with that of US, which has reported sensitivity ranging from 40% to 97% and specificity ranging from 64% to 100% (4)(5)(6)(7)(8)(9)(10)(11). Despite the difference in accuracy between the two modalities, the first-line imaging study when the presence of acute gallbladder disease is suspected is often US, primarily because of its widespread availability, lack of ionizing radiation, and ability to depict other causes of acute abdominal pain.…”

Section: Imaging Modalities and Radiopharmaceuticalsmentioning

confidence: 99%

Nuclear Medicine in the Acute Clinical Setting: Indications, Imaging Findings, and Potential Pitfalls

Uliel

Mellnick²,

Menias³

et al. 2013

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Nuclear medicine imaging provides valuable functional information that complements information obtained with anatomic imaging techniques in the evaluation of patients with specific acute clinical manifestations. Nuclear medicine studies are most often used in conjunction with other imaging modalities and as a problem-solving tool. Under certain circumstances a nuclear medicine study may be indicated as the first-line imaging modality, as in the case of renal scintigraphy for transplant dysfunction in the early postoperative period. Nuclear imaging may be preferred when a conventional first-line study is contraindicated or when it is important to minimize radiation exposure. The portability of nuclear imaging offers particular advantages for the evaluation of critically ill patients whose clinical condition is unstable and who cannot be safely transported out of the intensive care unit. The ability to visualize physiologic and pathophysiologic processes over relatively long time periods without adding to the patient's radiation exposure contributes to the high diagnostic sensitivity of several types of nuclear medicine studies. Viewing the acquired images in the cine mode adds to the value of these studies for diagnosing and characterizing dynamic abnormalities such as intermittent internal bleeding and bile or urine leakage. In this pictorial review, the spectrum of nuclear medicine studies commonly performed in the acute care setting is reviewed according to body systems and organs, with detailed descriptions of the indications, technical considerations, findings, and potential pitfalls of each type of study. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.332125098/-/DC1.

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Section: Imaging Modalities and Radiopharmaceuticalsmentioning

confidence: 99%

Nuclear Medicine in the Acute Clinical Setting: Indications, Imaging Findings, and Potential Pitfalls

Uliel

Mellnick²,

Menias³

et al. 2013

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“…Finally, scintigraphy is time-consuming, often requiring up to 4 hours for differentiation of acute from chronic cholecystitis (3). Many authors therefore suggest that nuclear imaging for the diagnosis of acute cholecystitis be reserved for patients with the rare equivocal sonogram (1,4,5).…”

Section: Introductionmentioning

confidence: 99%

From the RSNA Refresher Courses

Hanbidge¹,

Buckler²,

O’Malley³

et al. 2004

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Acute cholecystitis is the most common cause of acute pain in the right upper quadrant (RUQ), and urgent surgical removal of the gallbladder is the treatment of choice for uncomplicated disease. However, cross-sectional imaging is essential because more than one-third of patients with acute RUQ pain do not have acute cholecystitis. In addition, patients with complications of acute cholecystitis, such as perforation, are often best treated with supportive measures initially and elective cholecystectomy at a later date. Ultrasound (US) is the primary imaging modality for assessment of acute RUQ pain; US is both sensitive and specific in demonstrating gallstones, biliary dilatation, and features that suggest acute inflammatory disease. Occasionally, additional imaging modalities are indicated. Computed tomography is valuable, especially for confirming the extent and nature of the complications of acute cholecystitis. Magnetic resonance cholangiopancreatography is helpful in complicated ductal disease (eg, recurrent pyogenic cholangiohepatitis) when more detailed diagnostic information is required for treatment planning, whereas endoscopic retrograde cholangiopancreatography is used when biliary intervention is required (eg, treatment of choledocholithiasis). Successful imaging with all modalities requires familiarity with both the characteristic and the unusual features of a wide variety of pathologic conditions. In addition, potential pitfalls must be recognized and avoided.

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“…Plain abdominal radiographs may be helpful, but the serious choice for most clinicians with an acutely ill patient lies between ultrasound and ""Tc-IDA analog cholescintigraphy. As Laing et al'* and Shuman et al 25 point out, about one-third of patients with acute right upper quadrant pain will have acute cholecystitis. Shuman, with a less preselected patient group than in Weissmann et al's.…”

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confidence: 99%

Acute right upper quadrant abdominal pain: Ultrasound approach

Austin

1983

J of Clinical Ultrasound

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Acute right upper quadrant pain is a frequent presenting symptom in the general medical population. The expeditious proof of or exclusion of acute cholecystitis is a common diagnostic dilemma. The differential diagnosis of right upper quadrant pain in Schwarz' Textbook of Surgery (Table 1) is quite extensive with urgent surgery indicated in acute cholecystitis but not helpful or even contraindicated in the other conditions on that list. Even if acute cholecystitis seems the correct diagnosis clinically, the appropriate radiologic confirmatory test can be chosen from an almost equally long list. In this article, ultrasound will be assessed as the primary tool in the work-up of acute right upper quadrant pain due to acute cholecystitis.The sonographic sina-qua-non for gallbladder disease is cholelithiasis. Initial efforts focused upon the demonstration of gallstones using bistable, gray scale, and finally real-time ult r a~o u n d l -~ with increased accuracy, up to 94.5% in Raptopoulos investigation.' This latter study also demonstrated the relative speed and ease of real-time over articulated arm (Stark) ultrasound. Crade et al.4 and Simeone et al.5 evolved subcategories which today offer accuracy of up t o 100% in detecting gallstones. Category I is the "classic" gallstone: a clearly demonstrated gallbladder lumen containing a high amplitude echo (the gallstone) ( Fig. 1) with distal "clean" acoustic shadowing and gravity dependance as the patient moves from supine to oblique to upright positions (Fig. 2). This is virtually 100% diagnostic of cholelithiasis. Category I1 involves sonographic nonvisualization of the gallbladder lumen, despite fasting, often with high amplitude echoes in the gallbladder fossa with associated distal acoustic shadowing. Crade et al. achieved a 96% accuracy rate, with Harbin et a1.6 close at

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Evaluation of acute right upper quadrant pain: sonography and 99mTc-PIPIDA cholescintigraphy

Cited by 45 publications

References 18 publications

Nuclear Medicine in the Acute Clinical Setting: Indications, Imaging Findings, and Potential Pitfalls

Nuclear Medicine in the Acute Clinical Setting: Indications, Imaging Findings, and Potential Pitfalls

From the RSNA Refresher Courses

Acute right upper quadrant abdominal pain: Ultrasound approach

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