The American College of Radiology has developed clinical guidelines,
the Appropriateness Criteria,
based on the location of abdominal pain to help physicians choose the most appropriate imaging study.
US is the initial imaging test of choice for patients presenting with right upper quadrant
pain.
CT is recommended for evaluating right or left lower quadrant pain,
while conventional radiography has limited diagnostic value in the assessment of most patients with abdominal pain [3,8].
The value of US as a first line examination in the acute abdomen is indisputable,
as well as the correct diagnostic framework by the emergency physicians who is the first one to take care of the patient and who requires the first imaging exams.
US is an imaging tool that is able to demonstrate directly or indirectly pathological findings responsible for the patient symptoms.
Thanks to continuous technological development,
in recent years there have been more and more widespread low-dose protocols allowing to perform abdomen CT scan providing only a few mSv of radiation dose.
Our results show that abdominal US compared with CT in patients with aspecific acute abdominal pain has high positive predictive value,
but a low negative predictive value.
US has shown not to be reliable in excluding abdominal urgencies compared to CT,
especially in relation to gastrointestinal pathologies.
In our study 85% of the false negatives US examinations referred to pathologies of the gastrointestinal tract.
This evidence,
associated with the low diagnostic value of urgent US,
could suggest to perform CT scan as first line examination in patients with suspected pathology of the gastrointestinal tract.
This figure is absolutely in agreement with the most recent literature; over the past 20 years,
CT has emerged as the technique of choice for identifying the source of pain in most patients with an acute abdomen [4-7].
The result of our study shows the diagnostic value of abdomen CT and abdominal US in a different group of patients presenting to the emergency department with non-specific acute abdominal pain.
In conclusion we can affirm that an adequate clinical and diagnostic orientation is fundamental before to perform any diagnostic imaging test,
and if clinical suspicion of gastrointestinal disease is high,
CT could be considered as first-line imaging tecnique.