Nontraumatic Acute Abdominal Pain: Unenhanced Helical CT Compared with Three-View Acute Abdominal Series

MacKersie, Andrew; Lane, Michael J.; Gerhardt, Robert T.; Claypool, Harry A.; Keenan, Sean; Katz, Douglas S.; Tucker, Jonathan E.

doi:10.1148/radiol.2371040066

Cited by 119 publications

(87 citation statements)

References 19 publications

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“…The CT scan has sensitivity of 96% overall for diagnosing most causes of the acute abdomen, compared to a 30% sensitivity for plain films 13 . CT scanning has had a significant impact on the diagnosis of acute appendicitis as it has decreased the negative appendectomy rate from 24 to 3% 14 .…”

Section: Discussionmentioning

confidence: 99%

Clinical study, diagnostic aids and management of acute abdomen

Walia¹,

Kapur²,

Singh³

et al. 2017

Int. J. Curr. Res. Biol. Med

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Background: Evaluation of the emergency department(ED) patient with acute abdomen is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. The term acute abdomen is constantly applied to such cases that signify the urgent need for prompt diagnosis and active treatment. Objective: This study is designed to examine the present state of diagnosis and management of acute abdomen and to develop evidence based guidelines for the diagnostic pathway and management of acute abdomen. Result: Our study showed that acute cholecystitis was the most common cause (29%) in patients presenting with acute abdomen followed by perforation peritonitis (25%). Pain and vomiting (49%) was the most common complaint followed by distension (44%). Ultrasound is the most sensitive and most commonly used diagnostic aid in acute abdomen. Majority of patients(73%) required surgical intervention. Conclusion: Abdominal pain is a common presenting complaint in the ED and clinicians must consider multiple diagnoses, especially in those cases that require immediate intervention in order to limit morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Clinical study, diagnostic aids and management of acute abdomen

Walia¹,

Kapur²,

Singh³

et al. 2017

Int. J. Curr. Res. Biol. Med

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“…Although there is no defined value for maximum radiation dose to which a patient could be exposed, and there is a consensus that this patient should receive the dose required for the diagnosis, it would be desirable that this dose was as lowest as possible (32) . The dose utilized for each phase of multislice abdominal CT is about 12 to 20 mSv (33) . This would be the mean radiation dose reduction obtained upon suppression of one of the tomographic phases.…”

Section: Discussionmentioning

confidence: 99%

O valor da fase sem contraste na tomografia computadorizada do abdome

et al. 2008

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OBJECTIVE: To determine the role of the unenhanced phase of abdominal computed tomography in patients without a definite diagnosis or undergoing tumor staging. MATERIALS AND METHODS: A prospective and transversal study was developed with 100 consecutive patients submitted to unenhanced and contrastenhanced abdominal computed tomography. Two observers evaluated all the computed tomography images in the contrast-enhanced phase (first analysis) and, later, in the unenhanced phase (second analysis) in an attempt to establish the primary and secondary diagnoses as a function of the clinical indication for the study. The frequency of changes in the diagnoses resulting from a combined analysis of the images in the pre-and post-contrast phases was evaluated. Cases with changes in the diagnosis were reviewed by clinical specialists for determining possible changes in the therapeutic approach. RESULTS: Primary and secondary diagnoses were changed in respectively 1 and 18 cases (p = 1.000; p = 0.143) as follows: steatosis, adrenal nodules, nephrolithiasis, renal cysts and hepatic calcification. In the cases where the unenhanced phase changed the diagnosis, the specialists changed the therapeutic approach in 14 of the 19 patients (73%) (p = 0.038). CONCLUSION: No significant change was observed in the primary or secondary diagnosis as a result of the findings in the unenhanced phase. However, changes in secondary diagnoses affected the therapeutic approach adopted by the specialists. Keywords: Computed tomography; Contrast media; Abdomen.OBJETIVO: Determinar o valor agregado da fase sem meio de contraste da tomografia computadorizada do abdome em pacientes sem diagnóstico determinado ou em estadiamento tumoral. MATERIAIS E MÉTODOS: Estudo prospectivo e transversal em 100 pacientes consecutivos submetidos a tomografia computadorizada abdominal sem e com meio de contraste intravenoso. Dois examinadores avaliaram todos os exames, procurando estabelecer, através da fase com meio de contraste intravenoso (primeira análise) e posteriormente através da fase sem contraste (segunda análise), o diagnóstico principal e os secundários em função da indicação clínica do exame. Mediu-se a freqüência de mudança diagnóstica decorrente da análise combinada das fases pré-e pós-contraste intravenoso. Casos que tiveram mudança diagnóstica foram avaliados por especialistas clínicos para determinar se implicaria mudanças de conduta. RESULTADOS: Diagnósticos principal e secundário foram modificados em 1 e 18 casos, respectivamente (p = 1,000; p = 0,143). Os diagnósticos modificados foram: esteatose, definição de nódulo em adrenal, nefrolitíase, classificação de cistos renais e calcificação hepática. Nos casos em que a fase sem contraste modificou o diagnóstico, os especialistas mudaram sua conduta em 14/19 (73%) dos pacientes (p = 0,038). CONCLUSÃO: A fase sem contraste não modificou significativamente o diagnóstico principal ou secundário. Porém, as mudanças nos diagnós-ticos secundários influenciaram na conduta adotada pelos especialistas. Unite...

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“…31,39 Plain abdominal radiography is not accurate for pneumoperitoneum with studies on specificity ranging from 53% to 89.2%.39-42 False positive results can result in unnecessary laparotomy and needless exposure to general anaesthesia. 6,39 Undoubtedly, patients with pneumoperitoneum should urgently be taken to theatre. However, given advances in imaging and the availability of CT scanners, most patients with pneumoperitoneum on abdominal radiograph will have further imaging.…”

Section: Gastrointestinal Perforationmentioning

confidence: 99%

“…[3][4][5] Computed tomography (CT), as expected, has been shown to be more sensitive (96%) compared to plain abdominal radiographs (30%). 6 Despite this, plain abdominal radiographs are sensitive in selected patients -those with bowel obstruction, viscus perforation, foreign bodies and ureteric calculi. [6][7][8] Thus, one might argue that CT should be used first line, in certain instances if available, given its greater sensitivity in picking up pathology; however, one must remember that theradiation dose of CT should be considered as it is approximately ten times that of a plain abdominal film.…”

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confidence: 99%

Will Plain Abdominal Radiographs become Obsolete?

Ismail¹,

Malik²

2017

Radiol Open J

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Citation ABSTRACTPlain abdominal radiographs are often used as the first line investigation in diagnosing abdominal pathologies such as bowel obstruction and gastrointestinal perforation. However, their interpretation can often be non-specific. Given the reduction in radiation doses in recent years, This article reviews the role of plain abdominal radiographs and other imaging modalities in bowel obstruction and gastrointestinal perforation.

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Nontraumatic Acute Abdominal Pain: Unenhanced Helical CT Compared with Three-View Acute Abdominal Series

Cited by 119 publications

References 19 publications

Clinical study, diagnostic aids and management of acute abdomen

Clinical study, diagnostic aids and management of acute abdomen

O valor da fase sem contraste na tomografia computadorizada do abdome

Will Plain Abdominal Radiographs become Obsolete?

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