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J Am Coll Radiol. 2018 Nov;15(11S):S217-S231. doi: 10.1016/j.jacr.2018.09.010.

ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain.

Author information

1
Lahey Hospital and Medical Center, Burlington, Massachusetts. Electronic address: Christopher.scheirey@lahey.org.
2
Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
3
Research Author, Lahey Hospital and Medical Center, Burlington, Massachusetts.
4
Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin.
5
Georgetown University Hospital, Washington, District of Columbia; American College of Surgeons.
6
The University of South Florida Morsani College of Medicine, Tampa, Florida.
7
University of Texas McGovern Medical School, Houston, Texas; American Gastroenterological Association.
8
Newton-Wellesley Hospital, Newton, Massachusetts.
9
Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
10
Massachusetts General Hospital, Boston, Massachusetts.
11
University of Virginia Health System, Charlottesville, Virginia.
12
Medstar Georgetown University Hospital, Washington, District of Columbia.
13
Duke University Medical Center, Durham, North Carolina.
14
Emory University, Atlanta, Georgia.
15
The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.
16
Penn State Health, Hershey, Pennsylvania.
17
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
18
University of California San Francisco, San Francisco, California.
19
Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia.

Abstract

The range of pathology in adults that can produce abdominal pain is broad and necessitates an imaging approach to evaluate many different organ systems. Although localizing pain prompts directed imaging/management, clinical presentations may vary and result in nonlocalized symptoms. This review focuses on imaging the adult population with nonlocalized abdominal pain, including patients with fever, recent abdominal surgery, or neutropenia. Imaging of the entire abdomen and pelvis to evaluate for infectious or inflammatory processes of the abdominal viscera and solid organs, abdominal and pelvic neoplasms, and screen for ischemic or vascular etiologies is essential for prompt diagnosis and treatment. Often the first-line modality, CT quickly evaluates the abdomen/pelvis, providing for accurate diagnoses and management of patients with abdominal pain. Ultrasound and tailored MRI protocols may be useful as first-line imaging studies, especially in pregnant patients. In the postoperative abdomen, fluoroscopy may help detect anastomotic leaks/abscesses. While often performed, abdominal radiographs may not alter management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

KEYWORDS:

AUC; Abdomen; Abdominal pain; Abscess; Appropriate Use Criteria; Appropriateness Criteria; CT; Fever; Imaging

PMID:
30392591
DOI:
10.1016/j.jacr.2018.09.010
[Indexed for MEDLINE]

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