Diagnostic Imaging for Abdominal Pain

Initial Evaluation

For patients presenting with stomach pain, ultrasonography is the initial imaging study of choice for right upper quadrant pain, while CT with contrast media is recommended for right lower quadrant, left lower quadrant, or generalized abdominal pain. 1
Beta-human chorionic gonadotropin testing should be performed in all women of reproductive age before performing diagnostic imaging. 1

Consider cholescintigraphy or CT if ultrasonography is equivocal for suspected cholecystitis. 1

For suspected appendicitis or diverticulitis, CT with contrast is recommended. 1

CT of abdomen and pelvis with contrast media is typically the imaging modality of choice. 4
Consider CT angiography with contrast media if mesenteric ischemia is suspected. 5

For patients with fever and abdominal pain, obtain blood cultures and perform a chest radiograph. 6
For patients who have recently undergone thoracic, abdominal, or pelvic surgery, perform CT as part of the workup if etiology is not readily identified. 6
Plain radiographs have limited diagnostic value in the assessment of abdominal pain and should not be routinely used. 1
For suspected mesenteric ischemia, elevated lactate, leukocytosis, and D-dimer may assist in diagnosis, though none are definitive. 5
Over-reliance on a single laboratory parameter should be avoided, as no single test is sufficiently accurate to identify ischemic or necrotic bowel. 5