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Acute Nontraumatic Abdominal Pain in Adult Patients: Abdominal Radiography Compared with CT Evaluation¹

¹ From the Department of Diagnostic Imaging, Brown Medical School and Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. From the 1999 RSNA scientific assembly. Received July 26, 2001; revision requested September 17; final revision received April 1, 2002; accepted April 26. Address correspondence to W.W.M.S. (e-mail: william_mayo-smith@brown.edu).

View larger version (138K): [in a new window]   Figure 1a. Images obtained in a 22-year-old man with acute lower abdominal pain. (a) Supine abdominal radiograph is normal. (b) Transverse CT scan of the lower abdomen obtained with intravenously and orally administered contrast material shows extensive thickening of the terminal ileum and the cecum (arrow) consistent with Crohn disease.

View larger version (169K): [in a new window]   Figure 1b. Images obtained in a 22-year-old man with acute lower abdominal pain. (a) Supine abdominal radiograph is normal. (b) Transverse CT scan of the lower abdomen obtained with intravenously and orally administered contrast material shows extensive thickening of the terminal ileum and the cecum (arrow) consistent with Crohn disease.

View larger version (108K): [in a new window]   Figure 2a. Images obtained in a 39-year-old man with acute lower abdominal pain. (a) Abdominal radiograph shows a normal bowel gas pattern with possible nephrolithiasis (arrows) on the right side. (b) Follow-up transverse CT scan obtained with intravenously and orally administered contrast material through the pelvis demonstrates a tubular structure (arrow) with inflammatory changes in the right lower quadrant consistent with appendicitis, which was confirmed at surgery. No renal calculus was seen.

View larger version (162K): [in a new window]   Figure 2b. Images obtained in a 39-year-old man with acute lower abdominal pain. (a) Abdominal radiograph shows a normal bowel gas pattern with possible nephrolithiasis (arrows) on the right side. (b) Follow-up transverse CT scan obtained with intravenously and orally administered contrast material through the pelvis demonstrates a tubular structure (arrow) with inflammatory changes in the right lower quadrant consistent with appendicitis, which was confirmed at surgery. No renal calculus was seen.

View larger version (153K): [in a new window]   Figure 3a. Images obtained in a 65-year-old woman with lower abdominal pain. (a) Abdominal radiograph obtained with the patient supine demonstrates a nonobstructive bowel gas pattern. (b) Transverse CT scan obtained with intravenously administered contrast material through the pelvis reveals extensive sigmoid colonic wall thickening (arrow) and mesenteric stranding consistent with acute diverticulitis.

View larger version (151K): [in a new window]   Figure 3b. Images obtained in a 65-year-old woman with lower abdominal pain. (a) Abdominal radiograph obtained with the patient supine demonstrates a nonobstructive bowel gas pattern. (b) Transverse CT scan obtained with intravenously administered contrast material through the pelvis reveals extensive sigmoid colonic wall thickening (arrow) and mesenteric stranding consistent with acute diverticulitis.

View larger version (164K): [in a new window]   Figure 4a. Images obtained in a 43-year-old woman who had a history of abdominal surgery and presented with abdominal pain and vomiting. (a) Abdominal radiograph obtained with the patient supine demonstrates a nasogastric tube and no clinically important disease. (b) Transverse CT scan obtained with intravenously and orally administered contrast material shows multiple fluid-filled loops of small bowel consistent with small bowel obstruction. The diagnosis of small bowel obstruction from adhesions was confirmed at surgery.

View larger version (133K): [in a new window]   Figure 4b. Images obtained in a 43-year-old woman who had a history of abdominal surgery and presented with abdominal pain and vomiting. (a) Abdominal radiograph obtained with the patient supine demonstrates a nasogastric tube and no clinically important disease. (b) Transverse CT scan obtained with intravenously and orally administered contrast material shows multiple fluid-filled loops of small bowel consistent with small bowel obstruction. The diagnosis of small bowel obstruction from adhesions was confirmed at surgery.

View larger version (155K): [in a new window]   Figure 5a. Images obtained in a 49-year-old woman with right flank pain. (a) Abdominal radiograph demonstrates a 5-mm calcification in the right hemipelvis (arrowheads). The radiographic differential diagnosis included a phlebolith or a ureteral calculus. (b) Nonenhanced transverse CT scan through the pelvis demonstrates a distal right ureteral calculus (arrow).

View larger version (167K): [in a new window]   Figure 5b. Images obtained in a 49-year-old woman with right flank pain. (a) Abdominal radiograph demonstrates a 5-mm calcification in the right hemipelvis (arrowheads). The radiographic differential diagnosis included a phlebolith or a ureteral calculus. (b) Nonenhanced transverse CT scan through the pelvis demonstrates a distal right ureteral calculus (arrow).