Abdominal Radiology

, Volume 44, Issue 9, pp 2963–2970 | Cite as

Acute non-traumatic abdominal pain by quadrant: relative yield of CT and clinical evaluation for diagnosis in 1000 patients

  • Perry J. PickhardtEmail author
  • Leslie Nelson
Hollow Organ GI



To determine the relative diagnostic yield of contrast-enhanced CT in adults presenting with symptoms referable to a specific abdominal quadrant.


Electronic health records review systematically identified patients meeting the following inclusion criteria: adults (≥ 18 years) undergoing IV contrast-enhanced abdominopelvic CT for acute non-traumatic symptoms referable to a specific abdominal quadrant (RLQ/LLQ/LUQ/RUQ). The CT-based diagnosis and any clinical diagnosis in the absence of CT diagnosis were recorded. The final cohort of 1000 subjects (mean age, 48.1 years; 647F/353M) consisted of consecutive sub-cohorts of 250 patients for each abdominal quadrant. Positive oral contrast was utilized in 91.6% (916/1000) of cases.


A positive CT diagnosis was provided in 47.3% (473/1000) of all patients, and was highest for LLQ (58.8%) and RLQ (58.0%) symptoms, including diverticulitis and appendicitis in 23.6% and 24.8% cases, respectively. CT positivity was lower for the LUQ (34.4%) and RUQ (38.0%) (p < 0.0001), with no single diagnosis representing > 5% of cases. However, all quadrants provided valuable triage of 218 hospital admissions (21.8%), 83.0% were CT positive, whereas 62.7% of 782 discharged patients were CT negative. Only 7.0% of CT-negative patients were admitted. A clinical-only diagnosis was provided in 9.3% of the total cohort (93/1000), representing 17.6% of the CT-negative cohort (93/527).


The rate of positive CT diagnosis is considerably higher for the lower abdominal quadrants, predominately due to appendicitis and diverticulitis. However, CT results (positive vs. negative) for all four quadrants strongly correlated with hospital admission versus discharge. Clinical-only diagnosis represented < 10% of all cases.


CT Abdominal pain Appendicitis Diverticulitis 


Compliance with ethical standards

Conflict of interest

Relationships with industry: Dr. Pickhardt—advisor to Bracco; shareholder in SHINE, Elucent, and Cellectar. Dr. Nelson declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived for this retrospective study.


  1. 1.
    Pickhardt PJ, Lawrence EM, Pooler BD, Bruce RJ. Diagnostic Performance of Multidetector Computed Tomography for Suspected Acute Appendicitis. Annals of Internal Medicine 2011;154:789-U38CrossRefGoogle Scholar
  2. 2.
    Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. New England Journal of Medicine 1998;338:141-6CrossRefGoogle Scholar
  3. 3.
    Smith MP, Katz DS, Lalani T, et al. ACR Appropriateness Criteria(R) Right Lower Quadrant Pain--Suspected Appendicitis. Ultrasound quarterly 2015;31:85-91CrossRefGoogle Scholar
  4. 4.
    Balfe DM, Levine MS, Ralls PW, et al. Evaluation of left lower quadrant pain. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000;215 Suppl:167-71.Google Scholar
  5. 5.
    Ambrosetti P, Grossholz M, Becker C, Terrier F, Morel P. Computed tomography in acute left colonic diverticulitis. British Journal of Surgery 1997;84:532-4CrossRefGoogle Scholar
  6. 6.
    Rao PM, Rhea JT, Novelline RA, et al. Helical CT with only colonic contrast material for diagnosing diverticulitis: Prospective evaluation of 150 patients. American Journal of Roentgenology 1998;170:1445-9CrossRefGoogle Scholar
  7. 7.
    Ahn SH, Mayo-Smith WW, Murphy BL, Reinert SE, Cronan JJ. Acute nontraumatic abdominal pain in adult patients: Abdominal radiography compared with CT evaluation. Radiology 2002;225:159-64CrossRefGoogle Scholar
  8. 8.
    Rosen MP, Sands DZ, Longmaid HE, Reynolds KF, Wagner M, Raptopoulos V. Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. American Journal of Roentgenology 2000;174:1391-6CrossRefGoogle Scholar
  9. 9.
    Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP. National Trends in CT Use in the Emergency Department: 1995-2007. Radiology 2011;258:164-73CrossRefGoogle Scholar
  10. 10.
    Pescatori LC, Brambati M, Messina C, et al. Clinical impact of computed tomography in the emergency department in nontraumatic chest and abdominal conditions. Emerg Radiol 2018;25:393-8CrossRefGoogle Scholar
  11. 11.
    Abujudeh HH, Kaewlai R, McMahon PM, et al. Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center. AJR American journal of roentgenology 2011;196:238-43CrossRefGoogle Scholar
  12. 12.
    Pandharipande PV, Reisner AT, Binder WD, et al. CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making. Radiology 2016;278:812-21CrossRefGoogle Scholar
  13. 13.
    Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V. Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 2003;13:418-24Google Scholar
  14. 14.
    Nagurney JT, Brown DF, Chang Y, Sane S, Wang AC, Weiner JB. Use of diagnostic testing in the emergency department for patients presenting with non-traumatic abdominal pain. The Journal of emergency medicine 2003;25:363-71CrossRefGoogle Scholar
  15. 15.
    Pooler BD, Lawrence EM, Pickhardt PJ. Alternative Diagnoses to Suspected Appendicitis at CT. Radiology 2012;265:733-42CrossRefGoogle Scholar
  16. 16.
    Macari M, Balthazar EJ. The acute right lower quadrant: CT evaluation. Radiol Clin North Am 2003;41:1117-36CrossRefGoogle Scholar
  17. 17.
    Purysko AS, Remer EM, Filho HM, Bittencourt LK, Lima RV, Racy DJ. Beyond appendicitis: common and uncommon gastrointestinal causes of right lower quadrant abdominal pain at multidetector CT. Radiographics 2011;31:927-47CrossRefGoogle Scholar
  18. 18.
    Yarmish GM, Smith MP, Rosen MP, et al. ACR appropriateness criteria right upper quadrant pain. Journal of the American College of Radiology : JACR 2014;11:316-22CrossRefGoogle Scholar
  19. 19.
    van Randen A, Lameris W, van Es HW, et al. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol 2011;21:1535-45CrossRefGoogle Scholar
  20. 20.
    Pooler BD, Repplinger MD, Reeder SB, Pickhardt PJ. MRI of the Nontraumatic Acute Abdomen: Description of Findings and Multimodality Correlation. Gastroenterology clinics of North America 2018;47:667-90CrossRefGoogle Scholar
  21. 21.
    Repplinger MD, Pickhardt PJ, Robbins JB, et al. Prospective Comparison of the Diagnostic Accuracy of MR Imaging versus CT for Acute Appendicitis. Radiology 2018;288:467-75CrossRefGoogle Scholar
  22. 22.
    Kitchin DR, Lubner MG, Menias CO, Santillan CS, Pickhardt PJ. MDCT diagnosis of gastroduodenal ulcers: key imaging features with endoscopic correlation. Abdom Imaging 2015;40:360-84CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of RadiologyUniversity of Kentucky College of MedicineLexingtonUSA

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