Diagnostic Approach for Intermittent Right Upper Quadrant Abdominal Pain

Initial Diagnostic Approach

The American College of Radiology recommends ultrasonography of the abdomen as the first-line imaging study for an 18-year-old female presenting with intermittent right upper quadrant (RUQ) abdominal pain, due to its high appropriateness rating (9/9) and lack of radiation exposure 1, 2
Obtain a pregnancy test before any imaging studies for all females of reproductive age to rule out pregnancy-related conditions 3
Conduct urinalysis to evaluate for renal stones or infection 2

Ultrasonography of the abdomen is the first-line imaging modality with the highest appropriateness rating (9/9) according to the American College of Radiology (ACR) Appropriateness Criteria, and has several advantages including no radiation exposure, ready availability, and ability to identify gallbladder pathology, liver abnormalities, and other potential causes of RUQ pain 1, 2
Ultrasonography is particularly valuable for evaluating gallbladder disease, which is a common cause of RUQ pain 2

Consider cholescintigraphy (HIDA scan) as a second-line imaging option, particularly if gallbladder disease is suspected based on ultrasound findings, with an appropriateness rating of 6/9 1, 2
CT of abdomen with contrast media and MRI of abdomen without and with contrast media are also second-line imaging options, with appropriateness ratings of 6/9, and may be considered based on specific clinical circumstances 1, 2

Failing to obtain a pregnancy test before imaging studies in females of reproductive age can lead to unnecessary radiation exposure and delayed diagnosis 3
Relying solely on laboratory tests without appropriate imaging when indicated can result in missed diagnoses and delayed treatment 3
Using CT as first-line imaging due to unnecessary radiation exposure in young patients is not recommended, and ultrasonography should be considered as the initial imaging modality 3