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Imaging of acute right lower quadrant abdominal pain: differential diagnoses beyond appendicitis

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Abstract

Evaluation of acute right lower quadrant pain remains a common and challenging clinical scenario for emergency medicine physicians due to frequent nonspecific signs, symptoms, and physical examination findings. Therefore, imaging has evolved to play a pivotal role in the emergency setting. While appendicitis is a common cause for acute pain, there are numerous other important differential considerations with which the radiologist must be aware. The purpose of this review is to list an anatomy-based, encompassing differential diagnosis in addition to acute appendicitis for right lower quadrant pain; demonstrate the key imaging findings of numerous differential considerations; and describe helpful imaging and clinical features useful in narrowing the differential diagnosis.

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References

  1. Bhuiya FA, Pitts SR, McCaig LF (2010) Emergency department visits for chest pain and abdominal pain: United States, 1999–2008. NCHS Data Brief 43:1–8

    PubMed  Google Scholar 

  2. Abraham C, Cho JH (2009) Inflammatory bowel disease. N Engl J Med 361(21):2066–2078

    Article  PubMed  CAS  Google Scholar 

  3. Paulsen SR et al (2006) CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases. Radiographics 26(3):641–657, discussion 657–62

    Article  PubMed  Google Scholar 

  4. Horton KM, Corl FM, Fishman EK (2000) CT evaluation of the colon: inflammatory disease. Radiographics 20(2):399–418

    PubMed  CAS  Google Scholar 

  5. Lee SS et al (2002) CT of prominent pericolic or perienteric vasculature in patients with Crohn’s disease: correlation with clinical disease activity and findings on barium studies. AJR Am J Roentgenol 179(4):1029–1036

    PubMed  Google Scholar 

  6. Puylaert JB, Van der Zant FM, Mutsaers JA (1997) Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: clinical, radiological and US findings. Eur Radiol 7(1):3–9

    Article  PubMed  CAS  Google Scholar 

  7. Silva AC, Pimenta M, Guimaraes LS (2009) Small bowel obstruction: what to look for. Radiographics 29(2):423–439

    Article  PubMed  Google Scholar 

  8. Fukuya T et al (1992) CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR Am J Roentgenol 158(4):765–769, discussion 771–2

    PubMed  CAS  Google Scholar 

  9. Krummen DM, Camp LA, Jackson CE (1996) Perforation of terminal ileum diverticulitis: a case report and literature review. Am Surg 62(11):939–940

    PubMed  CAS  Google Scholar 

  10. Coulier B et al (2007) Diverticulitis of the small bowel: CT diagnosis. Abdom Imaging 32(2):228–233

    Article  PubMed  Google Scholar 

  11. Elsayes KM et al (2007) Imaging manifestations of Meckel’s diverticulum. AJR Am J Roentgenol 189(1):81–88

    Article  PubMed  Google Scholar 

  12. Purysko AS et al (2011) Beyond appendicitis: common and uncommon gastrointestinal causes of right lower quadrant abdominal pain at multidetector CT. Radiographics 31(4):927–947

    Article  PubMed  Google Scholar 

  13. Agha FP (1986) Intussusception in adults. AJR Am J Roentgenol 146(3):527–531

    PubMed  CAS  Google Scholar 

  14. Azar T, Berger DL (1997) Adult intussusception. Ann Surg 226(2):134–138

    Article  PubMed  CAS  Google Scholar 

  15. Telem DA et al (2009) Current recommendations on diagnosis and management of right-sided diverticulitis. Gastroenterol Res Pract 2009:359485

    PubMed  Google Scholar 

  16. O’Malley ME, Wilson SR (2003) US of gastrointestinal tract abnormalities with CT correlation. Radiographics 23(1):59–72

    Article  PubMed  Google Scholar 

  17. Landreneau RJ, Fry WJ (1990) The right colon as a target organ of nonocclusive mesenteric ischemia. Case report and review of the literature. Arch Surg 125(5):591–594

    Article  PubMed  CAS  Google Scholar 

  18. Matsushita M et al (1994) Malignant lymphoma in the ileocecal region causing intussusception. J Gastroenterol 29(2):203–207

    Article  PubMed  CAS  Google Scholar 

  19. Hoeffel C et al (2006) Multi-detector row CT: spectrum of diseases involving the ileocecal area. Radiographics 26(5):1373–1390

    Article  PubMed  Google Scholar 

  20. Wall SD, Jones B (1992) Gastrointestinal tract in the immunocompromised host: opportunistic infections and other complications. Radiology 185(2):327–335

    PubMed  CAS  Google Scholar 

  21. Delabrousse E et al (2007) Cecal volvulus: CT findings and correlation with pathophysiology. Emerg Radiol 14(6):411–415

    Article  PubMed  Google Scholar 

  22. Willms AB, Schlund JF, Meyer WR (1995) Endovaginal Doppler ultrasound in ovarian torsion: a case series. Ultrasound Obstet Gynecol 5(2):129–132

    Article  PubMed  CAS  Google Scholar 

  23. Kimura I et al (1994) Ovarian torsion: CT and MR imaging appearances. Radiology 190(2):337–341

    PubMed  CAS  Google Scholar 

  24. Borders RJ et al (2004) Computed tomography of corpus luteal cysts. J Comput Assist Tomogr 28(3):340–342

    Article  PubMed  Google Scholar 

  25. Baltarowich OH et al (1987) The spectrum of sonographic findings in hemorrhagic ovarian cysts. AJR Am J Roentgenol 148(5):901–905

    PubMed  CAS  Google Scholar 

  26. Lin EP, Bhatt S, Dogra VS (2008) Diagnostic clues to ectopic pregnancy. Radiographics 28(6):1661–1671

    Article  PubMed  Google Scholar 

  27. Wilbur AC, Aizenstein RI, Napp TE (1992) CT findings in tuboovarian abscess. AJR Am J Roentgenol 158(3):575–579

    PubMed  CAS  Google Scholar 

  28. Salomon O et al (1999) Risk factors associated with postpartum ovarian vein thrombosis. Thromb Haemost 82(3):1015–1019

    PubMed  CAS  Google Scholar 

  29. Zuckerman J et al (1997) Imaging of pelvic postpartum complications. AJR Am J Roentgenol 168(3):663–668

    PubMed  CAS  Google Scholar 

  30. Yang DM et al (2010) Sonographic findings of acute vasitis. J Ultrasound Med 29(12):1711–1715

    PubMed  Google Scholar 

  31. Rioux M, Langis P (1994) Primary epiploic appendagitis: clinical, US, and CT findings in 14 cases. Radiology 191(2):523–526

    PubMed  CAS  Google Scholar 

  32. van Breda Vriesman AC et al (1999) Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. Eur Radiol 9(9):1886–1892

    Article  PubMed  Google Scholar 

  33. Lucey BC, Stuhlfaut JW, Soto JA (2005) Mesenteric lymph nodes seen at imaging: causes and significance. Radiographics 25(2):351–365

    Article  PubMed  Google Scholar 

  34. Rao PM, Rhea JT, Novelline RA (1997) CT diagnosis of mesenteric adenitis. Radiology 202(1):145–149

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Suite 3950 PUH S. Tower, Pittsburgh, PA, 15213, USA

    Matthew T. Heller

  2. School of Medicine, University of Pittsburgh, 3550 Terrace St, M240 Scaife Hall, Pittsburgh, PA, 15261, USA

    Alexander Hattoum

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  1. Matthew T. Heller
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  2. Alexander Hattoum
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Correspondence to Matthew T. Heller.

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Heller, M.T., Hattoum, A. Imaging of acute right lower quadrant abdominal pain: differential diagnoses beyond appendicitis. Emerg Radiol 19, 61–73 (2012). https://doi.org/10.1007/s10140-011-0997-9

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  • DOI: https://doi.org/10.1007/s10140-011-0997-9

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