To elaborate the practical aspects of tailoring Helical CECT based upon the findings of a low-dose unenhanced CT abdomen in patient with acute abdomen. To study the CT appearances of common and uncommon acute abdominal conditions.

Acute abdomen is characterized by sudden onset of severe abdominal pain that requires the clinician to make an urgent therapeutic decision. Clinical diagnosis is often ambiguous with differentials ranging from benign self-limiting conditions to diseases that require urgent intervention. [1,2] Self-limiting causes: Gastroenteritis Lymphadenitis Epiploic appendagitis Appendicitis Cholecystitis Salpingitis Colonic diverticulitis Life threatening causes: Ruptured aortic aneurysm Necrotizing pancreatitis Bowel perforation Complicated diverticulitis Mesenteric ischemia How to proceed...... There are various international recommendationsfor approaching an acute abdomen i.e from the American college of Radiology, Royal...

In all patients, differential diagnosis was narrowed down into a working clinical diagnosis by actively communicating with the referring physician. Initially,an unenhanced low doseCT abdomenwas performed from the level of D10 vertebra down to the symphysis pubis with a current of 30 - 50mAs and pitch of greater than 1.5. The cumulative radiation dose of not more than 1.5 mSv was given. If a diagnosis was confidently established on the basis of the unenhanced CT study, no further imaging was carried out and patient was...

In our experience, almost 30% of the NECT studies were adequate to establish a reliable diagnosis. Similar percentage of patients were reliably and safely excluded for having a significant pathology. In remaining 40% cases, low dose NECT abdomen was followed by contrast enhanced CT that was tailored accordingly. This significantly reduced patient dose, un-necessary hospital stay and was also cost effective. In our opinion, we are still performing more contrast studies probably due to the lack of referral for unenhanced CT abdomen as a screening...

Dr Samar Hamid, MBBS, FCPS, EDiR, Radiologist, Department of Radiology, Jinnah Postgraduate Medical Center, Karachi, Pakistan Dr Naveed Ahmad, MBBS, MCPS, FRCR, FCPS, Consultant Radiologist, Department of Radiology, Jinnah Postgraduate Medical Center and National Medical Center, Karachi, Pakistan Dr Sadaf Imran, MBBS, FCPS, EDiR, Consultant Radiologist, Department of Radiology, Jinnah Postgraduate Medical Center, Karachi, Pakistan Dr Tariq Mahmood, MBBS, DMRD, FCPS, Head of Radiology and Cyberknife Robotic Radiosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan

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