ACR appropriateness criteria right upper quadrant pain.
Acute right upper quadrant pain is a common presenting symptom in patients with acute cholecystitis. When acute cholecystitis is suspected in patients with right upper quadrant pain, in most clinical scenarios, the initial imaging modality of choice is ultrasound. Although cholescintigraphy has been shown to have slightly higher sensitivity and specificity for diagnosis, ultrasound is preferred as the initial study for a variety of reasons, including greater availability, shorter examination time, lack of ionizing radiation, morphologic evaluation, confirmation of the presence or absence of gallstones, evaluation of bile ducts, and identification or exclusion of alternative diagnoses. CT or MRI may be helpful in equivocal cases and may identify complications of acute cholecystitis. When ultrasound findings are inconclusive, MRI is the preferred imaging test in pregnant patients who present with right upper quadrant pain. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Staten Island University Hospital, Staten Island, New York. Electronic address: gyarmish@gmail.com.
Gail M
GM
Yarmish
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Martin P
MP
Smith
University of Massachusetts Memorial Medical Center, Worcester, Massachusetts.
Max P
MP
Rosen
Cleveland Clinic, Cleveland, Ohio.
Mark E
ME
Baker
Massachusetts General Hospital, Boston, Massachusetts.
Michael A
MA
Blake
Walter Reed National Military Medical Center, Bethesda, Maryland; American Gastroenterological Association, Bethesda, Maryland.
Brooks D
BD
Cash
New York University Medical Center, New York, New York.
Nicole M
NM
Hindman
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ihab R
IR
Kamel
University of Texas MD Anderson Cancer Center, Houston, Texas.
Harmeet
H
Kaur
Duke University Medical Center, Durham, North Carolina.
Rendon C
RC
Nelson
Hartford Hospital, Hartford, Connecticut; American College of Surgeons, Chicago, Illinois.
Robert J
RJ
Piorkowski
University of California San Francisco, San Francisco, California.
Aliya
A
Qayyum
Milton S. Hershey Medical Center, Hershey, Pennsylvania; Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.
Mark
M
Tulchinsky
D000006:Abdomen, Acute / Q000175:diagnosis* / Q000209:etiology*; D002764:Cholecystitis / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D014481:United States
Appropriateness Criteria; abdominal pain; cholecystitis; cholescintigraphy; comparative studies; ultrasound