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Impact of Abdominal CT on the Management of Patients Presenting to the Emergency Department with Acute Abdominal Pain

Max P. Rosen1, Daniel Z. Sands2, H. Esterbrook Longmaid, III1, Kevin F. Reynolds1, Michelle Wagner3 and Vassillios Raptopoulos1

1 Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA 02215.
2 Department of Clinical Computing, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215.
3 Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215.



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  		Fig. 1A. —40-year-old man who presented to emergency department with hematuria and abdominal pain. Abdominal and pelvic CT scan obtained after administration of IV contrast medium. In retrospect, appendix (short arrow) is mildly dilated, measuring 7 mm in transverse diameter. Subtle streaking of pericolic fat is seen (long arrow). For comparison, fat along left iliac muscle (arrowhead) is of lower attenuation than that on right.

 


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  		Fig. 1B. —40-year-old man who presented to emergency department with hematuria and abdominal pain. CT image contiguous and caudal to A shows mild dilatation of appendix (short arrow) and high attenuation in retrocecal fat (long arrow). At surgery, patient was found to have retrocecal appendicitis.

 


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  		Fig. 2A. —44-year-old woman with right lower quadrant pain. CT scan shows inflammatory mass in right lower quadrant (arrow).

 


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  		Fig. 2B. —44-year-old woman with right lower quadrant pain. CT scan inferior to A shows dilated appendix with enhancing wall (arrow).

 


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  		Fig. 2C. —44-year-old woman with right lower quadrant pain. CT image contiguous and caudal to B shows dilated appendix (arrow) extending anterior and lateral to right colon.

 


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  		Fig. 2D. —44-year-old woman with right lower quadrant pain. CT scan obtained 4 weeks later after 14 days of oral antibiotics, and at same level as A, shows complete resolution of right lower quadrant inflammatory mass. Patient subsequently underwent laparoscopic appendectomy as an outpatient.

 

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