Ultrasonography of the acute abdomen (original) (raw)
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The role of US examination in the management of acute abdomen
Critical Ultrasound Journal, 2013
Acute abdomen is a medical emergency, in which there is sudden and severe pain in abdomen of recent onset with accompanying signs and symptoms that focus on an abdominal involvement. It can represent a wide spectrum of conditions, ranging from a benign and self-limiting disease to a surgical emergency. Nevertheless, only one quarter of patients who have previously been classified with an acute abdomen actually receive surgical treatment, so the clinical dilemma is if the patients need surgical treatment or not and, furthermore, in which cases the surgical option needs to be urgently adopted. Due to this reason a thorough and logical approach to the diagnosis of abdominal pain is necessary. Some Authors assert that the location of pain is a useful starting point and will guide a further evaluation. However some causes are more frequent in the paediatric population (like appendicitis or adenomesenteritis) or are strictly related to the gender (i.e. gynaechologic causes). It is also important to consider special populations such as the elderly or oncologic patients, who may present with atypical symptoms of a disease. These considerations also reflect a different diagnostic approach. Today, surely the integrated imaging, and in particular the use of multidetector Computed Tomography (MDCT) has revolutionised the clinical approach to this condition, simplyfing the diagnosis but burdening the radiologists with the problems related to the clinical management. However although CT emerging as a modality of choice for evaluation of the acute abdomen, ultrasonography (US) remains the primary imaging technique in the majority of cases, especially in young and female patients, when the limitation of the radiation exposure should be mandatory, limiting the use of CT in cases of nondiagnostic US and in all cases where there is a discrepancy between the clinical symptoms and negative imaging at US.
The role of ultrasonography in the diagnosis and management of non-traumatic acute abdominal pain
Internal and Emergency Medicine, 2008
Our aim was to assess the effects of initial ultrasonography (US) evaluation on the diagnosis and management of non-traumatic acute abdominal pain in the emergency department. Three hundred patients with the complaint of non-traumatic acute abdominal pain who were sent for US examination with an initial clinical impression were included in the study. Pre-US and post-US surveys were designed for the clinicians who requested US. The percentage concordance of US findings with the discharge diagnosis made by clinical follow-up, imaging modalities and surgery was determined by calculating the confidence interval. The concordance of the initial clinical impression and the US diagnosis with the discharge diagnosis were compared using the McNemar test. US could not detect any pathology in 102 (34%; 95%CI, 28.6-39.3%) of the patients. The US revealed a different diagnosis than the clinical impression in 69 (23%; 95%CI, 18.2-27.7%), and confirmed the diagnosis in 121 (40%; 95%CI, 34.4-45.5%) patients. The US changed the treatment plans in 47% (95%CI, 41.3-52.6%) of the patients. The clinicians stated US helped them ''very much'' or ''moderately'' in making a diagnosis in 83% (95%CI, 78.7-87.2%). When US results were compared with the discharge diagnosis, there was concordance in 238 (79.3%; 95%CI, 74.3-83.6%) patients but not in 62 (20.6%; 95%CI, 16-25.1%). Among 121 patients the initial clinical impression agreed with the US diagnosis and there was concordance with the discharge diagnosis in 105 (86.7%; 95%CI, 80-92.7%). The concordance of US findings with the discharge diagnosis was significantly higher than that of the initial clinical impression statistically. In the initial evaluation of the patients with acute abdominal pain, US is considerably helpful in making the correct diagnosis, and that the concordance with the discharge diagnosis is high. When whole abdominal scanning is not performed, targeted US study according to the initial clinical impression decreases the clinical benefit of US.
Role of computed tomography in non-traumatic acute abdomen in adults
Asian Journal of Medical Sciences
Background: The objective of this study was to study, assess, and diagnose causes of acute abdomen accurately, to determine the accuracy of multidetector computed tomography (CT) for confirmation of negative, diagnosed, or equivocal ultrasonography (USG) cases, and to establish role of CT as the primary imaging modality. Aims and Objective: To study, assess and diagnose causes of acute abdomen accurately, To determine the accuracy of MDCT for confirmation of Negative, diagnosed or equivocal USG cases & To establish role of CT as the primary imaging modality. Materials and Methods: One hundred and twenty random patients were included in this prospective study. USG and CT were done in all patients. Axial, coronal, and sagittal reformatted images were studied. Intravenous and oral contrast were also used depending on the clinical condition. All these patients were followed up diagnosis obtained before and after CT were compared with intraoperative findings or final clinical diagnosis a...
The acute abdomen: Current CT imaging techniques
Seminars in Ultrasound, CT and MRI, 1999
Currently, CT plays a pivotal role in the evaluation of the patient with an acute abdomen. Several competing techniques have been described and investigated. Each appears to possess advantages and disadvantages which will be examined. Each imaging center needs to modify these protocols to satisfy local scanner availability, patient demographics, radiologic expertise, and economic considerations.
USG and CT correlation of non-traumatic acute abdomen
Back ground: Of all patients presenting to the Emergency Department(ED), approximately 10% have complaints of acute abdominal pain. Non-traumatic acute abdominal pain is one of the most common symptoms in adults presenting to the emergency department. Clinical assessment is sufficient to decide on the level of urgency, but not on the specific cause of the acute abdominal pain. The causes of abdominal pain vary from life threatening to the self-limiting. Management decision on the basis of clinical and laboratory tests alone can result in unnecessary intervention or delayed management. Hence a diagnostic modality has to be formulated which aids in clinical diagnosis and prevents mortalities. CT scan and ultrasound now become principal investigation in non-traumatic acute abdomen. This study aims to correlate the usefulness of USG abdomen and CT abdomen in patients presenting with acute abdominal pain in emergency department. Materials and Methods: The present study of computed tomography and ultrasound evaluation of non-traumatic acute abdomen was a prospective study of 100 patients using ultra sound and CT scan modality. The present study is carried out at department of radiology, Guru Gobind Singh Hospital and M P Shah Medical College, Jamnagar. The study was carried out between 2017 to 2019. Results were checked by two radiologists (PI and CO-PI) and final comparative data wasprepared from Computed Tomography (CT) and Ultrasound study. Results: Out of 100 patients in this study, 65 % were male and 35% were female. Youngest patient was 11nonth-old female baby and oldest patient was 100-year-old female, majority of the patients were adults with highest number of them in the age group of 30-40 years (20 %), among our patients 100 patients (29%) showed changes of pancreatitis (13 %) showed appendicitis and small bowel obstruction other common conditions encountered were cholecystitis (13 %) and renal ureteric calculi (8%), USG abdomen was abnormal in 55.17% of the pancreatitis and 76% of patients with appendicitis and small bowel obstruction and 81% in patients with cholecystitis and 87% in patients with renal or ureteric calculi. Conclusion: In the present series of study conducted for correlation of CECT abdomen and USG abdomen in the evaluation of acute non-traumatic abdomen, CECT abdomen was more sensitive and accurate in diagnosing the causes of non-traumatic acute abdomen, although USG abdomen was proved to be valuable first hand tool in management of non-traumatic acute abdomen.
CT of the acute abdomen: findings and impact on diagnosis and treatment
American Journal of Roentgenology, 1994
An acute abdomen is a clinical condition characterized by severe abdominal pain that develops suddenly over several hours or less [1]. Abdominal tenderness and rigidity, either generalized or localized, usually are severe and indicate an urgent need for prompt diagnosis and treatment. The underlying cause of acute abdomen varies, and some cases require immediate surgical treatment, whereas for others, surgery is unnecessary or contraindicated. This need for prompt diagno
BMJ, 2009
Objective To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain. Design Fully paired multicentre diagnostic accuracy study with prospective data collection. Setting Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands. Participants 1021 patients with non-traumatic abdominal pain of >2 hours' and <5 days' duration. Exclusion criteria were discharge from the emergency department with no imaging considered warranted by the treating physician, pregnancy, and haemorrhagic shock. Intervention All patients had plain radiographs (upright chest and supine abdominal), ultrasonography, and computed tomography (CT) after clinical and laboratory examination. A panel of experienced physicians assigned a final diagnosis after six months and classified the condition as urgent or non-urgent. Main outcome measures Sensitivity and specificity for urgent conditions, percentage of missed cases and false positives, and exposure to radiation for single imaging strategies, conditional imaging strategies (CT after initial ultrasonography), and strategies driven by body mass index and age or by location of pain. Results 661 (65%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after ultrasonography or CT. CT detected more urgent diagnoses than did ultrasonography: sensitivity was 89% (95% confidence interval 87% to 92%) for CT and 70% (67% to 74%) for ultrasonography (P<0.001). A conditional strategy with CT only after negative or inconclusive ultrasonography yielded the highest sensitivity, missing only 6% of urgent cases. With this strategy, only 49% (46% to 52%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity. Conclusion Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominal pain, using ultrasonography first and CT only in those with negative or inconclusive ultrasonography results in the best sensitivity and lowers exposure to radiation.
American Journal of Roentgenology, 1997
The purpose of this study was to evaluate the effect of CT on the diagnosis and management of acute abdominal pain in patients who did not undergo surgery and to determine what population of patients would profit most from CT examination. MATERIALS AND METHODS. Clinical data and CT reports of 91 patients with acute abdomen (4 1 men and 50 women. 22-96 years old) were analyzed retrospectively. The accuracies