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Abstract Details
ACR Appropriateness Criteria® Right Upper Quadrant Pain: 2022 Update
J Am Coll Radiol. 2023 May;20(5S):S211-S223.doi: 10.1016/j.jacr.2023.02.011.
1University of Connecticut, Farmington, Connecticut. Electronic address: gkrusso@gmail.com.
2Johns Hopkins Hospital, Baltimore, Maryland.
3Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland.
4Panel Vice-Chair, University of Alabama Medical Center, Birmingham, Alabama; Council Steering Committee, ACR.
5Emory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER.
6Duke University Medical Center, Durham, North Carolina.
7University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association.
8Oregon Health & Science University, Portland, Oregon; Liver Reporting & Data System Technique Working Group.
9Duke Signature Care, Durham, North Carolina; American College of Physicians.
10University of Alabama at Birmingham, Birmingham, Alabama; Primary care physician.
11Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians.
12Oregon Health & Science University, Portland, Oregon; American College of Surgeons.
13NorthShore University HealthSystem, Evanston, Illinois.
14New York University Langone Medical Center, New York, New York.
15University of Cincinnati Medical Center, Cincinnati, Ohio.
16McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging.
17Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia.
Abstract
Acute right upper quadrant pain is one of the most common presenting symptoms in hospital emergency departments, as well as outpatient settings. Although gallstone-related acute cholecystitis is a leading consideration in diagnosis, a myriad of extrabiliary sources including hepatic, pancreatic, gastroduodenal, and musculoskeletal should also be considered. This document focuses on the diagnostic accuracy of imaging studies performed specifically to evaluate acute right upper quadrant pain, with biliary etiologies including acute cholecystitis and its complications being the most common. An additional consideration of extrabiliary sources such as acute pancreatitis, peptic ulcer disease, ascending cholangitis, liver abscess, hepatitis, and painful liver neoplasms remain a diagnostic consideration in the right clinical setting. The use of radiographs, ultrasound, nuclear medicine, CT, and MRI for these indications are discussed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.