From the Research
CT scans of the abdomen are indicated for left upper quadrant (LUQ) pain when there is suspected splenic pathology, pancreatitis, renal stones, abdominal aortic aneurysm, or when the clinical presentation is concerning for serious underlying conditions. Specific indications include severe or acute onset pain, pain associated with trauma, signs of peritonitis, unexplained fever, hypotension, persistent symptoms despite conservative management, or abnormal laboratory findings such as elevated lipase/amylase, leukocytosis, or anemia 1.
Key Indications for CT Abdomen in LUQ Pain
- Severe or acute onset pain
- Pain associated with trauma
- Signs of peritonitis
- Unexplained fever
- Hypotension
- Persistent symptoms despite conservative management
- Abnormal laboratory findings such as elevated lipase/amylase, leukocytosis, or anemia
CT is particularly valuable when evaluating for:
- Splenic infarction, abscess, or rupture
- Pancreatic inflammation or necrosis
- Renal stones or pyelonephritis
- Vascular issues like mesenteric ischemia
The imaging should be performed with intravenous contrast unless contraindicated by renal impairment or allergy, with typical protocols including portal venous phase imaging at 70-80 seconds post-contrast 2. For suspected renal stones, a non-contrast CT is preferred. CT is recommended over ultrasound when deeper structures need evaluation or when the patient's body habitus limits ultrasound visualization, though radiation exposure should be considered, especially in younger patients or those requiring repeated imaging 3, 4.
Considerations for Imaging Protocol
- Use of intravenous contrast unless contraindicated
- Portal venous phase imaging at 70-80 seconds post-contrast
- Non-contrast CT for suspected renal stones
- Consideration of radiation exposure, especially in younger patients or those requiring repeated imaging