Although sensitivity and specificity ranges are not routinely reported because of the wide spectrum of pathology encountered, there are sufficient data to suggest that CT with IV contrast adds diagnostic value and helps direct management. In a prospective study assessing impact of CT on management decisions in the ED, a total of 584 patients presented with nontraumatic abdominal complaints and CT changed leading diagnosis in 49%, changed admission status in 24%, and altered surgical plans in 25% [31]. In the same study, with concerns to etiologies associated with fever, the diagnosis of abscess decreased by 19% following CT, colitis and inflammatory bowel disease decreased by 12%, diagnosis of cholecystitis and cholangitis increased by 100%, and diagnosis of pelvic inflammatory disease increased by 280% following CT. Among intensive care unit patients with sepsis of unknown origin, CT of the abdomen and pelvis revealed the source of sepsis in 7 of 45 patients [32]. Pseudomembranous (ie, clostridium difficile) colitis is frequently encountered in the inpatient setting and is a common diagnostic consideration in a patient with fever; CT findings are present in the colon in 88% of cases [33]. Rarely, diffuse tumors such as lymphomas or metastases may present with abdominal pain and fever; CT with contrast will depict all abdominal organs and lymph node chains in the evaluation of potential malignancy. Acute Nonlocalized Abdominal Pain In addition to detection of an abscess, CT can also be used as guidance for percutaneous drainage. Percutaneous drainage is feasible and effective for the treatment of abdominopelvic abscess [34]. MRI Abdomen and Pelvis MRI is often performed with specific indications in mind, using tailored protocols. However, when optimized for the acute setting, MRI can be an accurate examination for detecting abdominal and pelvic abscesses [35].
Acute Nonlocalized Abdominal Pain. Although sensitivity and specificity ranges are not routinely reported because of the wide spectrum of pathology encountered, there are sufficient data to suggest that CT with IV contrast adds diagnostic value and helps direct management. In a prospective study assessing impact of CT on management decisions in the ED, a total of 584 patients presented with nontraumatic abdominal complaints and CT changed leading diagnosis in 49%, changed admission status in 24%, and altered surgical plans in 25% [31]. In the same study, with concerns to etiologies associated with fever, the diagnosis of abscess decreased by 19% following CT, colitis and inflammatory bowel disease decreased by 12%, diagnosis of cholecystitis and cholangitis increased by 100%, and diagnosis of pelvic inflammatory disease increased by 280% following CT. Among intensive care unit patients with sepsis of unknown origin, CT of the abdomen and pelvis revealed the source of sepsis in 7 of 45 patients [32]. Pseudomembranous (ie, clostridium difficile) colitis is frequently encountered in the inpatient setting and is a common diagnostic consideration in a patient with fever; CT findings are present in the colon in 88% of cases [33]. Rarely, diffuse tumors such as lymphomas or metastases may present with abdominal pain and fever; CT with contrast will depict all abdominal organs and lymph node chains in the evaluation of potential malignancy. Acute Nonlocalized Abdominal Pain In addition to detection of an abscess, CT can also be used as guidance for percutaneous drainage. Percutaneous drainage is feasible and effective for the treatment of abdominopelvic abscess [34]. MRI Abdomen and Pelvis MRI is often performed with specific indications in mind, using tailored protocols. However, when optimized for the acute setting, MRI can be an accurate examination for detecting abdominal and pelvic abscesses [35].