Abdominal Computed Tomography

CT is the diagnostic tool of choice for many acute abdominal conditions. CT is the first imaging study of choice for patients with suspected diverticulitis, pancreatitis, pancreatic pseudocyst, aortic aneurysm, blunt trauma, and appendicitis. The diagnosis of appendicitis can be made on clinical evaluation, but CT has been proven remarkably sensitive and specific in confirming the diagnosis.11 Whether patients with suspected appendicitis require oral, intravenous, and/or rectal contrast versus "no-contrast" thin cuts through the ileocecal area is debated in the radiology literature. 12 CT is a useful adjunct to plain films in suspected cases of intestinal ischemia, where specific findings may include pneumotosis intestinalis, portal venous gas, mesenteric vessel occlusion, and enlargement of a thrombosed vein. 13 While patients with suspected small bowel obstruction should be imaged initially with plain radiographs, CT has similar sensitivity in revealing obstruction, both high and low grade. When CT correctly showed a small bowel obstruction, the cause of the obstruction was demonstrated in 95 percent of cases. CT offers a further advantage to the emergency physician evaluating the patient with multiple potential causes for acute abdominal pain. While never advocated as a "screening tool," CT scanning can pinpoint a diagnosis in 95 percent of cases where clinical judgment and other imaging studies fail to narrow a wide range of potential diagnoses. 14

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