Emergency Radiology of the Abdomen and Pelvis: Imaging of the Nontraumatic and Traumatic Acute Abdomen

  • Jay P. Heiken
  • Douglas S. Katz


A very large range of disorders, from benign, self-limited conditions to processes requiring emergency surgery, can present with acute abdominal and pelvic pain. The radiologist plays a substantial role in the routine diagnosis and management of patients with these disorders. Similarly, the radiologist plays a major role in the routine evaluation as well as follow-up of selected patients with abdominal and pelvic trauma, whether blunt or penetrating. Computed tomography (CT) remains the mainstay of evaluating such patients, and protocols have evolved along with technological advancements. Ultrasound (US) has a continued important role, particularly for evaluating right upper quadrant pain, suspected gynecologic disorders, and pediatric and pregnant patients with an acute abdomen. Magnetic resonance imaging (MRI) has a growing role in initial evaluation as well as follow-up of selected patients with a variety of acute abdominal and pelvic conditions (usually nontraumatic). Although it is not possible to cover every aspect of imaging of acute nontraumatic and traumatic conditions of the abdomen and pelvis in a single chapter, an overview is presented, with key concepts and teaching points.


Abdominal Aortic Aneurysm Compute Tomography Finding Pelvic Inflammatory Disease Acute Abdomen Blunt Abdominal Trauma 
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Suggested Reading

  1. Ahn SH, Mayo-Smith WW, Murphy BL et al (2002) Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation. Radiology 225:159–164.PubMedCrossRefGoogle Scholar
  2. Anderson SW, Soto JA, Lucey BC et al (2009) Abdominal 64-MDCT for suspected appendicitis: the use of oral and IV contrast material versus IV contrast material only. AJR Am J Roentgenol 193:1282–1288.PubMedCrossRefGoogle Scholar
  3. Atri M, Hanson JM, Grinblat L et al (2008) Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT evaluation. Radiology 249:524–533.PubMedCrossRefGoogle Scholar
  4. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174:331–336.PubMedCrossRefGoogle Scholar
  5. Boscak AR, Shanmuganathan K, Mirvis SE et al (2013) Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology 268:79–88.PubMedCrossRefGoogle Scholar
  6. Desir A, Ghaye B (2012) CT of blunt diaphragmatic rupture. RadioGraphics 32:477–498.PubMedCrossRefGoogle Scholar
  7. Dewhurst C, Beddy P, Pedrosa I (2013) MRI evaluation of acute appendicitis in pregnancy. J Magn Reson Imaging 37:566–575.PubMedCrossRefGoogle Scholar
  8. Drasin TE, Anderson SW, Asandra A et al (2001) MDCT evaluation of blunt abdominal trauma: clinical significance of free intraperitoneal fluid in males with absence of identifiable injury. AJR Am J Roentgenol 191:1821–1826.CrossRefGoogle Scholar
  9. Fuks D, Mouly C, Robert B et al (2012) Acute cholecystitis: preoperative CT can help the surgeon consider conversion from laparoscopic to open cholecystectomy. Radiology 263:128–138.PubMedCrossRefGoogle Scholar
  10. Gordon RW, Anderson SW, Ozonoff A et al (2013) Blunt pancreatic trauma: evaluation with MDCT technology. Emerg Radiol 20:259–266.PubMedCrossRefGoogle Scholar
  11. Gore RM, Miller FH, Pereles FS et al (2000) Helical CT in the evaluation of the acute abdomen. AJR Am J Roentgenol 174:901–913.PubMedCrossRefGoogle Scholar
  12. Hines J, Rosenfeld J, Duncan DR et al (2013) Perforation of the mesenteric small bowel: etiologies and CT findings. Emerg Radiol 20:155–161.PubMedCrossRefGoogle Scholar
  13. Katz DS, Khalid M, Coronel EE, Mazzie JP (2013) Computed tomography imaging of the acute pelvis in females. Can Assoc Radiol J 64:108–118.PubMedCrossRefGoogle Scholar
  14. Katz DS, Klein MA, Ganson G, Hines JJ (2012) Imaging of abdominal pain in pregnancy. Radiol Clin North Am 50:149–171.PubMedCrossRefGoogle Scholar
  15. Katz DS, Scheirey CD, Bordia R et al (2013) Computed tomography of miscellaneous regional and diffuse small bowel disorders. Radiol Clin North Am 51:45–68.PubMedCrossRefGoogle Scholar
  16. Keyzer C, Cullus P, Tack D et al (2009) MDCT for suspected acute appendicitis in adults: impact of oral and IV contrast media at standard-dose and simulated low-dose techniques. AJR Am J Roentgenol 193:1272–1281.PubMedCrossRefGoogle Scholar
  17. LeBedis CA, Anderson SW, Soto JA (2012) CT imaging of blunt traumatic bowel and mesenteric injuries. Radiol Clin North Am 50:123–136.PubMedCrossRefGoogle Scholar
  18. Lee SS, Park SH (2013) Computed tomography evaluation of gastrointestinal bleeding and acute mesenteric ischemia. Radiol Clin North Am 51:29–43.PubMedCrossRefGoogle Scholar
  19. Levenson RB, Camacho MA, Horn E et al (2012) Eliminating routine oral contrast use for CT in the emergency department: impact on patient throughput and diagnosis. Emerg Radiol 19:513–517.PubMedCrossRefGoogle Scholar
  20. Lucey BC, Varghese JC, Anderson SW, Soto JA (2006) Spontaneous hemoperitoneum: a bloody mess. Emerg Radiol 14:65–75.CrossRefGoogle Scholar
  21. MacKersie AB, Lane MJ, Gerhardt RT et al (2005) Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series. Radiology 237:114–122.PubMedCrossRefGoogle Scholar
  22. Marmery H, Shanmuganathan K, Alexander MT, Mirvis SE (2007) Optimization of selection of nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol 189:1421–1427.PubMedCrossRefGoogle Scholar
  23. Mellnick VM, McDowell C, Lubner M et al (2012) CT features of blunt abdominal aortic injury. Emerg Radiol 19:301–307.PubMedCrossRefGoogle Scholar
  24. Mirvis SE, Shanmuganagthan K (2007) Imaging hemidiaphragmatic injury. Eur Radiol 17:1411–1421.PubMedCrossRefGoogle Scholar
  25. Moore EE, Cogbill TH, Jurkovich GJ et al (1995) Organ injury scaling: spleen and liver (1994 revision). J Trauma 38:323–324.PubMedCrossRefGoogle Scholar
  26. Moore EE, Shackford SR, Pachter HL et al (1989) Organ injury scaling: spleen, liver, and kidney. J Trauma 29:1664–1666.PubMedCrossRefGoogle Scholar
  27. Orwig D, Federle MP (1989) Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR Am J Roentgenol 153:747–749.PubMedCrossRefGoogle Scholar
  28. Pooler BD, Lawrence EM, Pickhardt PJ (2012) Alternative diagnoses to suspected appendicitis at CT. Radiology 265:733–742.PubMedCrossRefGoogle Scholar
  29. Rapp EJ, Naim F, Kadivar K et al (2013) Integrating MR imaging into the clinical workup of pregnant patients suspected of having appendicitis is associated with a lower negative laparotomy rate: a single-institution study. Radiology 267:137–144.PubMedCrossRefGoogle Scholar
  30. Rosen MP, Ding A, Blake MA et al (2011) ACR Appropriateness Criteria right lower quadrant pain — suspected appendicitis. JACR 8:749–755.PubMedGoogle Scholar
  31. Santillan CS (2013) Computed tomography of small bowel obstruction. Radiol Clin North Am 51:17–27.PubMedCrossRefGoogle Scholar
  32. Shakespear JS, Shaaban AM, Rezvani M (2010) CT findings of acute cholecystitis and its complications. AJR Am J Roentgenol 194:1523–1529.PubMedCrossRefGoogle Scholar
  33. Singh AK, Gervais DA, Hahn PF et al (2005) Acute epiploic appendagitis and its mimics. RadioGraphics 25:1521–1534.PubMedCrossRefGoogle Scholar
  34. Smith RC, Varanelli M (2000) Diagnosis and management of acute ureterolithiasis. AJR Am J Roentgenol 175:3–6.PubMedCrossRefGoogle Scholar
  35. Soto JA, Anterson SW (2012) Multidetector CT of blunt abdominal trauma. Radiology 265:678–693.PubMedCrossRefGoogle Scholar
  36. Stojer J, van Randen A, Lameris W, Boermeester MA (2009) Imaging patients with acute abdominal pain. Radiology 253:31–46.CrossRefGoogle Scholar
  37. Stuhlfaut JW, Lucey BC, Varghese JC, Soto JA (2006) Blunt abdominal trauma: utility of 5-minute delayed CT with a reduced radiation dose. Radiology 238:473–479.PubMedCrossRefGoogle Scholar
  38. Thoeni RF (2012) The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology 262:751–764.PubMedCrossRefGoogle Scholar
  39. Werner A, Diehl SJ, Farag-Soliman M, Duber C (2003) Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients. Eur Radiol 13:2596–2603.PubMedCrossRefGoogle Scholar
  40. Wieseler KM, Bhargava P, Kanal KM et al (2010) Imaging in pregnant patients: examination appropriateness. RadioGraphics 30:1215–1229.PubMedCrossRefGoogle Scholar
  41. Yu J, Fulcher AS, Wang DB et al (2010) Frequency and importance of small amount of isolated pelvic free fluid detected with multidetector CT in male patients with blunt trauma. Radiology 256:799–805.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Jay P. Heiken
    • 1
  • Douglas S. Katz
    • 2
  1. 1.Mallinckrodt Institute of RadiologyWashington University School of MedicineSt. LouisUSA
  2. 2.Department of RadiologyWinthrop-University HospitalMineolaUSA

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