A -year-old man is brought to the emergency department due to the sudden onset of severe, diffuse abdominal pain that began hours ago. He reports nausea and one episode of non-bloody, non-bilious emesis. His medical history is significant for hypertension, type 2 diabetes mellitus, chronic kidney disease with a baseline serum creatinine of , and paroxysmal atrial fibrillation. He was prescribed apixaban but admits to missing multiple doses over the past week. His temperature is (), blood pressure is , pulse is and irregularly irregular, and respirations are . Pulse oximetry shows on room air. Physical examination reveals a patient in visible distress, writhing in pain on the stretcher. However, abdominal examination shows a soft, non-distended abdomen with only mild diffuse tenderness to deep palpation; there is no rebound, guarding, or rigidity. Bowel sounds are decreased. Laboratory studies show:
Leukocyte count:
Hemoglobin:
Platelet count:
Serum creatinine:
Blood urea nitrogen:
Serum lactate:
Which of the following is the most appropriate next step in diagnostic imaging for this patient?
- Computed tomography angiography of the abdomen and pelvisAnswer
- BNon-contrast computed tomography of the abdomen and pelvis
- CMesenteric duplex ultrasonography
- DMagnetic resonance angiography of the abdomen and pelvis
- ERight upper quadrant abdominal ultrasonography