POSTER SECTIONS Coverpage Learning objectives Background Findings and procedure details Conclusion Personal information and conflict of interest References

ECR 2023 / C-17862

ABDOMINAL - the ticket to the theater

Congress:

ECR 2023

Poster Number:

C-17862

Type:

Educational Exhibit

Keywords:

Abdomen, Emergency, CT, CT-Angiography, Contrast agent-intravenous, Structured reporting, Surgery, Acute

Authors:

G. Rotariu, I. Sava, D. H. Olaru, C. Lupascu-Ursulescu, D. Negru

DOI:

10.26044/ecr2023/C-17862

DOI-Link:

https://dx.doi.org/10.26044/ecr2023/C-17862

Learning objectives

• to provide a simple method of memorizing the basic differential diagnosis of non-traumatic abdominal emergencies (NTAE) - the ABDOMINAL mnemonic;• to highlight the CT findings that influence the management of a patient presenting with NTAE;• to discuss what interests the surgeon in each of these pathologies, therefore what is important to include in the report.

Background

A large proportion of Emergency Department (ED) admissions is attributed to non-traumatic acute abdominal pain. Since its cause must be discerned from a large series of conditions of varying severity, some requiring emergency surgery, its management places great stress on the clinician and radiologist. CT has become almost indispensable in the diagnostic practice for NTAE, due to the best performances regarding sensitivity and specificity. [1] We propose systemizing the differential diagnosis of NTAE in the form of the ABDOMINAL mnemonic, which also reunites the most...

Findings and procedure details

In the ED the aim of the abdominopelvic CT should be to achieve a high degree of discrimination between the pathologies that require urgent surgical intervention versus those that need conservative treatment, as well as to highlight the aspects that may further influence patient management. Following the most recent updates to the surgical guidelines, we further review the key CT features to note when assessing a potential NTAE surgical candidate, based on the diagnoses presented in the mnemonic. A: APPENDICITIS Complicated appendicitis (gangrenous or perforated)...

Conclusion

When facing an abdominopelvic CT with the diagnosis of acute abdominal pain, knowing the main differential diagnoses and the CT findings that influence the therapeutic decision - surgery versus conservative treatment is essential for a punctual, well-written report that leads to a good collaboration with the surgery department and further, to correct and prompt management of the patient.

Personal information and conflict of interest

G. Rotariu: Nothing to disclose I. Sava: Nothing to disclose D. H. Olaru: Nothing to disclose C. Lupascu-Ursulescu: Nothing to disclose D. Negru: Nothing to disclose

References

[1] Cross R, Bhat R, Li Y, Plankey M, Maloy K. Emergency Department Computed Tomography Use for Non-traumatic Abdominal Pain: Minimal Variability. West J Emerg Med. 2018 Sep;19(5):782-796. (PMID: 30202488) [2] Evangelou K, Acute abdominal pain differential diagnosis (mnemonic). Reference article, Radiopaedia.org. https://doi.org/10.53347/rID-91970. [3] Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines.World J Emerg Surg. 2020;15(1):27. (PMID: 32295644) [4] Ip C, Wang EH, Croft M, Lim W. Appendiceal Intraluminal Gas:...

Fig 1: The main differential diagnosis of non-traumatic abdominal pain and indications...

Fig 2: Axial, portal venous phase CT. There are a few extraluminal gas bubbles...

Fig 3: Sagittal, portal venous phase CT. Appendix (arrow) with prececal orientation....

Fig 4: Axial, portal venous phase CT. An appendicolith (arrow) is impacted at the base...

Fig 5: Oblique MPR, arterial phase CT. Distended gallbladder, with irregular mucosal...

Fig 6: Oblique MPR, portal venous phase CT. Irregular thickened-walled gallbladder...

Fig 7: Axial, arterial phase CT. Gallbladder with a thick wall that has been breached...

Fig 8: Axial, portal venous phase CT. Gas within the wall of the gall bladder with an...

Fig 9: Axial, portal venous phase CT. Inhomogeneous cystic lesion located in hepatic...

Fig 10: Oblique MPR, portal venous phase CT. The sigmoid wall is thickened with an...

Fig 11: Axial, portal venous phase CT. Circumferential mural thickening of the sigmoid...

Fig 12: Axial MPR, portal venous phase CT. Laying anterior to the uterus (asterisk) and...

Fig 13: Axial, pre-contrast CT. The left ovary shows increased volume and high density...

Fig 14: Axial, portal venous phase CT of the same patient. There is no enhancement of...

Fig 15: Axial portal venous phase. High-density fluid is seen in the pelvis reflecting...

Fig 16: Axial, arterial phase. Sigmoid circumferential mural thickening with contrast...

Fig 17: Oblique MPR, arterial phase CT. Irregular antral gastric wall thickening...

Fig 18: Axial, portal venous phase. Irregular circumferential wall thickening of the...

Fig 19: Axial MPR, portal venous phase of a patient with suspected intestinal ischemia....

Fig 20: Axial MPR, arterial phase CT of a patient suspected of mesenteric ischemia....

Fig 21: Axial MPR, precontrast CT scan of a patient on anticoagulant therapy,...

Fig 22: Axial MPR, portal venous phase CT. Grossly dilated loop of sigmoid colon with...

Fig 23: Axial, portal venous phase CT of a patient with a surgical history of umbilical...

Fig 24: Axial, nephrogenic phase CT. Dilation of the pyelo-calyceal system containing a...

Fig 25: Axial, nephrogenic phase CT. Left renal cortical and subcapsular collection of...

Fig 26: Axial, nephrogenic phase CT. Severe structural alteration of the right kidney...

Fig 27: Axial, arterial phase. Extensive ill-defined pancreatic inflammation with...

Fig 28: Axial portal venous phase CT. The corporeo-caudal pancreatic parenchyma is...

Fig 29: Axial arterial phase CT of the same patient. The source of the hemorrhage is a...