Internal and Emergency Medicine

, Volume 5, Issue 5, pp 401–409 | Cite as

The role of emergency ultrasound in the diagnosis of acute non-traumatic epigastric pain

  • Americo TestaEmail author
  • Ernesto Cristiano Lauritano
  • Rosangela Giannuzzi
  • Giulia Pignataro
  • Ivo Casagranda
  • Nicolò Gentiloni Silveri
IM - Review


The epigastrium is the site where pain coming from both abdominal and extraabdominal organs is frequently referred. Although acute or chronic diseases of the stomach, duodenum, liver, pancreas and biliary tree are the most common causes of acute epigastric pain, several other entities, potentially more severe, should also be suspected and investigated. Clinical bedside ultrasonography (US) is actually the first-line imaging in acute epigastric pain patients presenting to the hospital Emergency Department (ED) because it is rapid, noninvasive, relatively inexpensive and focused, repeatable and reliable. Moreover, the systematic use of emergency US as a complement to routine management might save economic resources by avoiding further costs for complications and substantially reducing the time for making an accurate diagnosis. The purpose of this paper is to review the US spectrum of the most common diseases responsible for acute epigastric pain onset. We also propose a focused, well codified US protocol, that we call the “$ approach”, based on our clinical experience and the current literature for acute non-traumatic epigastric pain evaluation in an emergency setting. Its systematic application by the emergency physician may reduce the wait for diagnosis and the over-usage of second-line radiological techniques, including computed tomography, as well as to increase the diagnostic accuracy with potential benefits for patient (safety), physician (efficacy) and the institution (efficiency).


Acute epigastric pain Ultrasonography Abdominal pain Emergency ultrasound Emergency care 


Conflict of interest



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Copyright information

© SIMI 2010

Authors and Affiliations

  • Americo Testa
    • 1
    • 3
    Email author
  • Ernesto Cristiano Lauritano
    • 2
  • Rosangela Giannuzzi
    • 1
  • Giulia Pignataro
    • 1
  • Ivo Casagranda
    • 2
  • Nicolò Gentiloni Silveri
    • 1
  1. 1.Emergency DepartmentA. Gemelli University HospitalRomeItaly
  2. 2.Emergency DepartmentSS. Antonio e Biagio e C. Arrigo HospitalAlessandriaItaly
  3. 3.A. Gemelli University HospitalRomeItaly

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