Radiography Abdomen Abdominal radiography is a commonly used first-line imaging modality for patients presenting with acute abdominal pain. Radiography has been shown to be of value for patients with suspected foreign body, bowel obstruction, and bowel perforation [18]. Several studies reported a high specificity of radiography in diagnosing small-bowel obstruction. However, it lacks the sensitivity and specificity of diagnosing other causes of abdominal pain [18-20]. A 2015 study showed that radiographs have lower sensitivity in detecting major abnormalities and supplemental imaging such as CT or US revealed major abnormalities in an additional 22% of patients whose radiographs were interpreted as normal [21]. Abdominal radiography has shown low utility in the diagnosis of common etiologies of abdominal pain, especially right upper quadrant pain including biliary and hepatic disease, acute pancreatitis, and peptic ulcer disease, and the findings can be noncontributory. Specifically, the inherent low soft tissue contrast of abdominal radiographs prevents diagnosis of typical right upper quadrant diseases including AC and hepatic pathologies. Gallstones, a common cause of biliary colic, are radiopaque in only 15% to 20% cases, and hence, the majority of the stones being radiolucent remain occult on radiography [22]. Several prospective studies [18,20,23] concluded that radiographs added only minimal value beyond clinical evaluation in the diagnostic workup of patients with acute abdominal pain. Few recent studies have analyzed the utility of abdominal radiographs for right upper quadrant pain specifically. Abdominal radiography has little utility as initial imaging for right upper quadrant abdominal pain with low sensitivity of 30% and has not been proven to be of value for expected other expected diagnoses, most importantly right upper quadrant pain [20,24]. US Abdomen US is the most useful modality for evaluation of right upper quadrant abdominal pain.
Right Upper Quadrant Pain. Radiography Abdomen Abdominal radiography is a commonly used first-line imaging modality for patients presenting with acute abdominal pain. Radiography has been shown to be of value for patients with suspected foreign body, bowel obstruction, and bowel perforation [18]. Several studies reported a high specificity of radiography in diagnosing small-bowel obstruction. However, it lacks the sensitivity and specificity of diagnosing other causes of abdominal pain [18-20]. A 2015 study showed that radiographs have lower sensitivity in detecting major abnormalities and supplemental imaging such as CT or US revealed major abnormalities in an additional 22% of patients whose radiographs were interpreted as normal [21]. Abdominal radiography has shown low utility in the diagnosis of common etiologies of abdominal pain, especially right upper quadrant pain including biliary and hepatic disease, acute pancreatitis, and peptic ulcer disease, and the findings can be noncontributory. Specifically, the inherent low soft tissue contrast of abdominal radiographs prevents diagnosis of typical right upper quadrant diseases including AC and hepatic pathologies. Gallstones, a common cause of biliary colic, are radiopaque in only 15% to 20% cases, and hence, the majority of the stones being radiolucent remain occult on radiography [22]. Several prospective studies [18,20,23] concluded that radiographs added only minimal value beyond clinical evaluation in the diagnostic workup of patients with acute abdominal pain. Few recent studies have analyzed the utility of abdominal radiographs for right upper quadrant pain specifically. Abdominal radiography has little utility as initial imaging for right upper quadrant abdominal pain with low sensitivity of 30% and has not been proven to be of value for expected other expected diagnoses, most importantly right upper quadrant pain [20,24]. US Abdomen US is the most useful modality for evaluation of right upper quadrant abdominal pain.