Learning objectives
To review the disease entities causing acute pain in the right upper quadrant.
To discuss the role of ultrasonography in the assessment of patients presenting with this symptom.
Additionally,
we will briefly discuss the value of tomography as a problem-solving tool.
Background
An acute abdomen means a disorder of sudden onset with duration of less 24 hours that is manifested as abdominal pain and associated with gastrointestinal symptoms.
Abdominal pain in the right upper quadrant is a very common symptom and constitutes a recognized pattern in which hepatobiliary disease in general (e.g.
acute cholecystitis) is the primary diagnostic consideration.
Although the patient history,
physical examination,
and laboratory test results can narrow the differential diagnosis,
these findings are sometimes confusing and imaging is generally indicated in order to...
Findings and procedure details
The ultrasonography (US) is the primary and initial imaging modality of choice for patients presenting with right upper quadrant pain,
although there are situations where additional imaging may be required,
namely computed tomography (CT).
The most common causes of acute pain in the abdominal quadrants are listed below:
Acute cholecystitis and its complications (gangrene cholecystitis,
emphysematous cholecystitis and gallbladder perforation)
Choledocholithiasis
Ascending cholangitis
Liver abscess
Acute pancreatitis
Painful liver neoplasms
Hepatic artery aneurysm
Budd-chiari syndrome
Perforated duodenal ulcer
Gallstone ileus
Intraperitoneal focal fat infarction
Ascending...
Conclusion
The radiologists must be familiar with the spectrum of conditions that may manifest as acute right upper quadrant pain.
Ultrasonography is the pivotal imaging modality to help explain the clinical picture,
which in turn is fundamental to select the prompt and adequate treatment.
Nevertheless,
there are some clinical situations that computed tomography may be a reliable tool to a best evolution,
improving the accuracy in the final diagnosis.
References
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Hanbidge AE,
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Spence SC,
Teichgraeber D,
Chandrasekhar C.Emergent right upper quadrant sonography.J Ultrasound Med.
2009 Apr;28(4):479-96
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Kuzmich S,
Harvey CJ,
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Tan KL.Perforated pyloroduodenal peptic ulcer and sonography.AJR Am J Roentgenol.
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Yagan N,
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Extension of air into the right perirenal space after duodenal perforation: CT findings.Radiology....