 Introduction/Background Acute right upper quadrant pain is one of the most common presenting symptom in hospital emergency departments, as well as outpatient settings. Although gallstone-related acute cholecystitis (AC) is a leading consideration in diagnosis, a myriad of extrabiliary sources including hepatic, pancreatic, gastroduodenal, and musculoskeletal should also be considered. Cholelithiasis is a common entity and AC is a common manifestation of gallstone disease afflicting more than 20 million people in the United States and is the leading cause of inpatient admissions for gastrointestinal disease [6]. AC can be life-threatening; therefore, timely diagnosis is essential for proper treatment. However, most patients with AC experience right upper quadrant abdominal pain, nausea, vomiting, anorexia, and fever [7]. Information derived only from clinical history, physical examination, and routine laboratory tests has not yielded acceptable likelihood ratios sufficient to predict the presence or absence of AC. Also, this information does not yield sufficient diagnostic certainty for making management decisions. Therefore, imaging studies play a major role in establishing a diagnosis of AC and assessing possible alternate diagnoses if AC is not present [8]. Unless otherwise stated, the ratings and recommendations for this document specifically relate to the adult nonpregnant patient. OR aUniversity of Connecticut, Farmington, Connecticut. bJohns Hopkins Hospital, Baltimore, Maryland. cPanel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland. dPanel Vice-Chair, University of Alabama Medical Center, Birmingham, Alabama. eEmory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER. fDuke University Medical Center, Durham, North Carolina. gUniversity of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association. hOregon Health & Science University, Portland, Oregon.
Right Upper Quadrant Pain.  Introduction/Background Acute right upper quadrant pain is one of the most common presenting symptom in hospital emergency departments, as well as outpatient settings. Although gallstone-related acute cholecystitis (AC) is a leading consideration in diagnosis, a myriad of extrabiliary sources including hepatic, pancreatic, gastroduodenal, and musculoskeletal should also be considered. Cholelithiasis is a common entity and AC is a common manifestation of gallstone disease afflicting more than 20 million people in the United States and is the leading cause of inpatient admissions for gastrointestinal disease [6]. AC can be life-threatening; therefore, timely diagnosis is essential for proper treatment. However, most patients with AC experience right upper quadrant abdominal pain, nausea, vomiting, anorexia, and fever [7]. Information derived only from clinical history, physical examination, and routine laboratory tests has not yielded acceptable likelihood ratios sufficient to predict the presence or absence of AC. Also, this information does not yield sufficient diagnostic certainty for making management decisions. Therefore, imaging studies play a major role in establishing a diagnosis of AC and assessing possible alternate diagnoses if AC is not present [8]. Unless otherwise stated, the ratings and recommendations for this document specifically relate to the adult nonpregnant patient. OR aUniversity of Connecticut, Farmington, Connecticut. bJohns Hopkins Hospital, Baltimore, Maryland. cPanel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland. dPanel Vice-Chair, University of Alabama Medical Center, Birmingham, Alabama. eEmory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER. fDuke University Medical Center, Durham, North Carolina. gUniversity of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association. hOregon Health & Science University, Portland, Oregon.