Type:
Educational Exhibit
Keywords:
Contrast agent-intravenous, Ultrasound, CT-Angiography, CT, Gastrointestinal tract, Emergency, Abdomen, Acute, Inflammation
Authors:
A. G. Tucci1, C. Massimo2, B. Cusati1, M. Di Meo3, A. Ragozzino1; 1Napoli/IT, 2Naples/IT, 3Pozzuoli/IT
DOI:
10.1594/ecr2018/C-1682
Background
Acute abdominal pain accounts for up to 7-10% of all emergency department visit per year,
with RLQ pain responsible for a large percentage of these cases.
Acute appendicitis is the most common abdominal surgical emergency in the world,
with around 300000 appendicectomies performed annually in the United States.
Typically,
young patients are affected (between 10 and 20 years old),
with a lifetime risk estimated to be around 8.6% in males and 6.9% in females.
The first evaluation of a patient with RLQ pain is based on anamnestic data,
clinical findings,
blood tests and ultrasound (Table 1).
When appendicitis is ruled out,
a broad spectrum of pathologies can be suspected,
including inflammatory,
infectious and neoplastic diseases involving the right iliac fossa.
Since clinical findings are not specific with pain,
tenderness,
fever,
high level of white blood cells,
nausea and vomit,
one or more imaging studies are often necessary to guide the diagnosis.
We will discuss imaging findings of uncommon causes of RLQ pain,
focusing on intestinal and mesenteric pathologies: inflammatory,
infectious and neoplastic diseases of the ileo-cecal region,
right colon diverticulitis,
small bowel diverticulitis,
Meckel's diverticulitis,
epiploic appendagitis and omental infarction (Table 2).