Examkin

Question

Difficulty: EasyOrdering Imaging Studies

A 58-year-old woman presents to the emergency department complaining of left lower quadrant abdominal pain that has progressively worsened over the past 48 hours. She reports associated nausea, decreased appetite, and a subjective fever. She has a history of hyperlipidemia and chronic constipation but no previous episodes of similar abdominal pain. Her temperature is 38.3°C (100.9°F), blood pressure is 128/78 mmHg, pulse is 90/min, and respirations are 16/min. Abdominal examination demonstrates focal tenderness to palpation in the left lower quadrant with voluntary guarding, but no rebound tenderness or rigidity. Bowel sounds are hypoactive. Laboratory evaluation reveals a leukocyte count of 14,500/mm³. Which of the following is the most appropriate initial diagnostic study for this patient?

  1. Computed tomography (CT) scan of the abdomen and pelvis with intravenous contrastAnswer
  2. B
    Magnetic resonance imaging (MRI) of the abdomen and pelvis
  3. C
    Colonoscopy
  4. D
    Plain radiography of the abdomen
  5. E
    Barium enema

Answer

Computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast
The patient's presentation of left lower quadrant pain, fever, localized guarding, and leukocytosis is highly suspicious for acute diverticulitis. In a hemodynamically stable patient, a computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast is the most appropriate initial diagnostic study. It has excellent sensitivity and specificity for confirming the diagnosis by demonstrating bowel wall thickening and pericolic fat stranding. Furthermore, it accurately identifies complications such as an abscess, fistula, or free intra-abdominal air that would alter clinical management.

Step-by-Step Solution

1
Identify the clinical syndrome presented by the patient based on history and physical examination.
The patient has acute-onset left lower quadrant pain, fever, and leukocytosis, which constitutes the classic presentation for acute diverticulitis.
Recognizing the most likely clinical diagnosis is required to select the evidence-based diagnostic algorithm.
2
Determine the optimal diagnostic imaging modality for this specific condition.
A CT scan of the abdomen and pelvis with intravenous contrast is the modality of choice.
CT imaging provides excellent visualization of the bowel wall and pericolic fat, establishing the diagnosis while effectively ruling out complications such as abscesses or fistulas.

Key Concept

The diagnostic standard for suspected acute diverticulitis in a hemodynamically stable patient is a CT scan of the abdomen and pelvis with intravenous contrast.
Rate this question

Topics

Ordering Imaging Studies

More questions from this topic