Is a CT (Computed Tomography) abdomen and pelvis scan okay?

CT Abdomen and Pelvis for Evaluation of Abdominal and Pelvic Pathology

CT abdomen and pelvis with IV contrast is appropriate and recommended for comprehensive evaluation of abdominal and pelvic pathology, providing excellent visualization of organs, vasculature, and potential abnormalities. 1

Indications and Benefits

CT abdomen and pelvis is particularly valuable in the following clinical scenarios:

• Trauma evaluation: For hemodynamically stable patients with blunt trauma, CT with IV contrast in the portal venous phase (70 seconds after contrast administration) is recommended for optimal characterization of solid organ injuries and genitourinary system assessment 1

• Suspected retroperitoneal bleeding: CT can rapidly confirm or exclude bleeding, localize areas of active extravasation, and identify potential causes 1

• Urinary tract evaluation: While CT urography (CTU) is preferred for detailed urinary tract assessment, standard CT abdomen/pelvis with IV contrast can detect many urinary tract abnormalities 1

• Evaluation of hydronephrosis: CT without contrast is useful for determining the level and cause of obstruction, particularly when urolithiasis is suspected 1

Protocol Considerations

Contrast Administration

• IV contrast is strongly recommended unless contraindicated (e.g., renal failure, contrast allergy)
• Portal venous phase (70 seconds post-contrast) is ideal for most evaluations 1
• Oral contrast is generally not recommended for trauma evaluation as it can delay diagnosis without improving sensitivity or specificity 1

Special Situations

1. Renal failure:

   • Unenhanced CT is preferred when evaluating patients with acute kidney injury 1
   • Risk-benefit assessment should be performed if contrast is needed

2. Suspected urinary tract pathology:

   • CT urography (CTU) with unenhanced, nephrographic, and excretory phases provides more comprehensive evaluation of the urinary tract 2
   • Consider CTU for hematuria evaluation, which has high diagnostic accuracy for detecting urothelial malignancies 3

3. Trauma patients:

   • Whole-body CT may be considered for high-velocity trauma, though clinical judgment remains vital 1
   • CTA may be needed if active arterial bleeding is suspected 1

Common Pitfalls and Limitations

• Non-contrast CT limitations: Lower sensitivity for detecting visceral organ and vascular injuries compared to contrast-enhanced studies 1
• Radiation exposure: Consider radiation dose, particularly in younger patients
• Contrast-related risks: Nephrotoxicity and allergic reactions must be considered
• Limited bladder evaluation: Standard CT may miss some bladder pathology; dedicated CT cystography may be needed for suspected bladder injury 1

CT abdomen and pelvis provides excellent anatomic detail and can detect a wide range of pathologies, making it an appropriate imaging modality for comprehensive evaluation of abdominal and pelvic conditions when clinically indicated.