kUniversity of Virginia Health System, Charlottesville, Virginia. lMedstar Georgetown University Hospital, Washington, District of Columbia. mDuke University Medical Center, Durham, North Carolina. nEmory University, Atlanta, Georgia. oThe Warren Alpert School of Medicine at Brown University, Providence, Rhode Island. pPenn State Health, Hershey, Pennsylvania. qBeth Israel Deaconess Medical Center, Boston, Massachusetts. rUniversity of California San Francisco, San Francisco, California. sSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Acute Nonlocalized Abdominal Pain Discussion of Procedures by Variant Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging. Patients suspected of having abdominal abscesses may present in a number of ways: with fever, with diffuse or localized abdominal pain, or with a history of a condition that may predispose to abdominal abscesses, such as appendicitis, diverticulitis, inflammatory bowel disease, pancreatitis, etc. In addition, some malignant conditions (including lymphoma and necrotizing masses), as well as masses producing secondary infections, such as cholangitis in the setting of a pancreatic malignancy, could all present with abdominal pain and fever. Radiography Abdomen Although the use of radiographs has shown high sensitivity (90%) for detecting intra-abdominal foreign bodies and moderate sensitivity for detecting bowel obstruction (49%), its low sensitivity for sources of abdominal pain and fever or abscess limit its role in this setting [15].
Acute Nonlocalized Abdominal Pain. kUniversity of Virginia Health System, Charlottesville, Virginia. lMedstar Georgetown University Hospital, Washington, District of Columbia. mDuke University Medical Center, Durham, North Carolina. nEmory University, Atlanta, Georgia. oThe Warren Alpert School of Medicine at Brown University, Providence, Rhode Island. pPenn State Health, Hershey, Pennsylvania. qBeth Israel Deaconess Medical Center, Boston, Massachusetts. rUniversity of California San Francisco, San Francisco, California. sSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Acute Nonlocalized Abdominal Pain Discussion of Procedures by Variant Variant 1: Acute nonlocalized abdominal pain and fever. No recent surgery. Initial imaging. Patients suspected of having abdominal abscesses may present in a number of ways: with fever, with diffuse or localized abdominal pain, or with a history of a condition that may predispose to abdominal abscesses, such as appendicitis, diverticulitis, inflammatory bowel disease, pancreatitis, etc. In addition, some malignant conditions (including lymphoma and necrotizing masses), as well as masses producing secondary infections, such as cholangitis in the setting of a pancreatic malignancy, could all present with abdominal pain and fever. Radiography Abdomen Although the use of radiographs has shown high sensitivity (90%) for detecting intra-abdominal foreign bodies and moderate sensitivity for detecting bowel obstruction (49%), its low sensitivity for sources of abdominal pain and fever or abscess limit its role in this setting [15].