The Differential Diagnosis of Right Lower Quadrant Pain: Radiological Clarification

Abstract

The authors deserve a compliment for their excellent presentation, but a further clarification should be made concerning the necessary radiological studies. The patient with an acute abdomen (the subject of the article) should be studied not with abdominal plain films, but rather with an erect abdominal or left lateral decubitus view, and always with a horizontal beam projection. The patient must maintain this position for five to ten minutes. Only in this way can a perforation of the intestinal tract – e.g., in diverticulitis – be detected by the presence of air under the diaphragm on the right side, and only in this way can fluid levels be seen whose differing heights convey useful information about peristaltic activity. A chest x-ray should always be performed as well, with the patient standing, if possible. Urinary calculi should be sought with a non-contrast-enhanced CT scan as the imaging method of choice; a contrast-enhanced scan can be performed immediately afterward, of course, to answer other questions. Excretion urography is of secondary importance.