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Diagnostic imaging plays a key role in the management of patients with acute abdominal pain. A precise diagnosis based on clinical findings alone is usually not possible, and diagnostic imaging should therefore be used liberally, especially if surgical treatment might be necessary. In elderly or debilitated patients, the clinical presentations of serious abdominal conditions can be muted, so a low threshold for ordering radiography and especially CT should be maintained (Esses et al. 2004). However, when a patient is unstable or an imaging study would delay emergency surgery, diagnostic imaging should be omitted.

In the past, abdominal radiography was the primary imaging modality even though its diagnostic accuracy for most disorders is limited. With the introduction of CT and ultrasonography, the scope of imaging diagnosis has expanded greatly. Other imaging modalities include nuclear scintigraphy, enteric contrast studies, and angiography. The choice of imaging study is based on the diagnoses suspected (Table 1).

Table 1 Diagnostic Imaging Based on Suspected Diagnosis

CT has the greatest diagnostic capabilities and is the test of choice in most patients presenting with significant abdominal pain. CT has high sensitivity for many abdominal disorders and can often detect alternative diagnoses when the primary disorder is not present.

Radiography is indicated in patients with suspected peptic ulcer perforation and small or large bowel obstruction. Because emergency clinicians are often called upon to interpret radiographs, conventional radiography is the focus of the cases in this section. In addition, knowledge about the radiographic manifestations of these disorders is important in understanding the radiologist’s report.

Radiographic Views

Three radiographic views should be obtained in an abdominal series: supine and upright abdominal views and ...

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