Role of Ultrasound and CT in the Workup of Right Upper Quadrant Pain in Adults in the Emergency Department: A Retrospective Review of More Than 2800 Cases

Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

“…12 Even with these stringent criteria, CT had a negative predictive value of 90% and approached 95% when applying a less strict (one feature) criterion. 12 As a result, an abdominal ultrasound will rarely diagnose cholecystitis after a normal CT.…”

“…Abdominal ultrasound has a sensitivity for the diagnosis of acute cholecystitis of 81%, with a specificity of 83%, 9 while CT has a comparable 85% to 94% 9,10 sensitivity and specificity ranging from 59% to 99% 9,11 . A recent study using more stringent radiographic criteria (two or more abnormal features) for diagnosing acute cholecystitis found ultrasound and CT had near equivalent sensitivities of 61% and 55%, respectively 12 . Even with these stringent criteria, CT had a negative predictive value of 90% and approached 95% when applying a less strict (one feature) criterion 12 .…”

“…A recent study using more stringent radiographic criteria (two or more abnormal features) for diagnosing acute cholecystitis found ultrasound and CT had near equivalent sensitivities of 61% and 55%, respectively 12 . Even with these stringent criteria, CT had a negative predictive value of 90% and approached 95% when applying a less strict (one feature) criterion 12 . As a result, an abdominal ultrasound will rarely diagnose cholecystitis after a normal CT.…”

SONO case series: right upper quadrant point-of-care ultrasound in assessment of the gallbladder

“…While there is ongoing discussion regarding the diagnostic accuracy of POCUS compared with radiology-performed ultrasound or CT for cholecystitis, POCUS offers a short study time, is correlated with a shorter ED length of stay and precludes the need to transport patients out of their rooms 13 15–17. These benefits may be attenuated by the skill of the operator and limited consultant confidence,18 although some evidence suggests similar test characteristics between ED RUQ POCUS and radiology-performed studies 6…”

Transvaginal US vs. CT in non-pregnant premenopausal women presenting to the ED: clinical impact of the second examination when both are performed

“…Not infrequently, both U.S. and CT are performed sequentially, not necessarily in this order, when the initial test fails to adequately address the perceived clinical concern. When possible, utilizing a single, high-yield imaging examination is optimal, as it may decrease time to diagnosis, length of stay in the ED, and overall visit cost [ 10 ]. CT has been shown to frequently identify an alternative source of symptoms from the suspected indication, as shown in multiple series, including one where an alternative to suspected appendicitis was delineated by CT in up to 31.6% of patients or another where an alternative to mesenteric ischemia was identified in up to 61% of patients [ 11 , 12 ].…”