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Do we really need additional contrast-enhanced abdominal computed tomography for differential diagnosis in triage of middle-aged subjects with suspected biliary pain.

Hwang IK, Lee YS, Kim J, Lee YJ, Park JH, Hwang JH - Medicine (Baltimore) (2015)

Bottom Line: Retrospectively, pre-contrast phase and multiphase CT findings were reviewed and the detection rate of findings suggesting disease requiring significant treatment by noncontrast CT (NCCT) was compared with cases detected by multiphase CT.Approximately 70% of total subjects had a significant condition, including 1 case of gallbladder cancer and 126 (68.8%) cases requiring intervention (122 biliary stone-related diseases, 3 liver abscesses, and 1 liver hemangioma).Biliary stones and liver space-occupying lesions were found equally on NCCT and multiphase CT.Calculated probable rates of overlooking acute cholecystitis and biliary obstruction were maximally 6.8% and 4.2% respectively.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si (IKH, YSL, JK, J-HH); Department of Internal Medicine, Wonkwang University College of Medicine, Wonkwang University Sanbon Hospital, Gunpo (IKH) and Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea (YJL, JHP).

ABSTRACT
Enhanced computed tomography (CT) is widely used for evaluating acute biliary pain in the emergency department (ED). However, concern about radiation exposure from CT has also increased. We investigated the usefulness of pre-contrast CT for differential diagnosis in middle-aged subjects with suspected biliary pain.A total of 183 subjects, who visited the ED for suspected biliary pain from January 2011 to December 2012, were included. Retrospectively, pre-contrast phase and multiphase CT findings were reviewed and the detection rate of findings suggesting disease requiring significant treatment by noncontrast CT (NCCT) was compared with cases detected by multiphase CT.Approximately 70% of total subjects had a significant condition, including 1 case of gallbladder cancer and 126 (68.8%) cases requiring intervention (122 biliary stone-related diseases, 3 liver abscesses, and 1 liver hemangioma). The rate of overlooking malignancy without contrast enhancement was calculated to be 0% to 1.5%. Biliary stones and liver space-occupying lesions were found equally on NCCT and multiphase CT. Calculated probable rates of overlooking acute cholecystitis and biliary obstruction were maximally 6.8% and 4.2% respectively. Incidental significant finding unrelated with pain consisted of 1 case of adrenal incidentaloma, which was also observed in NCCT.NCCT might be sufficient to detect life-threatening or significant disease requiring early treatment in young adults with biliary pain.

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Related in: MedlinePlus

Etiology of suspected biliary pain according to clinical significance. The overall final etiologic groupings were classified into 4 categories: life-threatening conditions (group A), significant diseases requiring intervention (group B), significant diseases requiring follow-up (group C), and insignificant conditions (group D).
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Figure 2: Etiology of suspected biliary pain according to clinical significance. The overall final etiologic groupings were classified into 4 categories: life-threatening conditions (group A), significant diseases requiring intervention (group B), significant diseases requiring follow-up (group C), and insignificant conditions (group D).

Mentions: The overall final etiologic groupings according to clinical significance are described in Fig. 2. In the study, Group A contained only 1 case of gallbladder cancer (0.5%) out of a total of 183 subjects. Group B included GB stone, CBD stone, acute cholecystitis, acute cholangitis, liver abscess, a huge liver hemangioma, which caused RUQ pain (68.8%). Group C consisted of hepatitis, gastric ulcer, appendicitis, Fitz-Hugh-Curtis syndrome (9.3%). Group D included muscular tear or no definite etiology (21.9%). Approximately 70% of total subjects had a “significant” condition. When comparing clinical relevance, according to age and presence of history with biliary stone disease, patients aged between 40 and 49 years had more “significant” diseases than those 40 years or younger (81.9% vs 58.0%, P = 0.001) (unpublished data). In the subgroup with a history of biliary stone, 44 of 48 (91.7%) had a “significant” condition, as opposed to 82 of 135 (60.7%) subjects without a history of biliary stone (P < 0.001) (unpublished data).


Do we really need additional contrast-enhanced abdominal computed tomography for differential diagnosis in triage of middle-aged subjects with suspected biliary pain.

Hwang IK, Lee YS, Kim J, Lee YJ, Park JH, Hwang JH - Medicine (Baltimore) (2015)

Etiology of suspected biliary pain according to clinical significance. The overall final etiologic groupings were classified into 4 categories: life-threatening conditions (group A), significant diseases requiring intervention (group B), significant diseases requiring follow-up (group C), and insignificant conditions (group D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554168&req=5

Figure 2: Etiology of suspected biliary pain according to clinical significance. The overall final etiologic groupings were classified into 4 categories: life-threatening conditions (group A), significant diseases requiring intervention (group B), significant diseases requiring follow-up (group C), and insignificant conditions (group D).
Mentions: The overall final etiologic groupings according to clinical significance are described in Fig. 2. In the study, Group A contained only 1 case of gallbladder cancer (0.5%) out of a total of 183 subjects. Group B included GB stone, CBD stone, acute cholecystitis, acute cholangitis, liver abscess, a huge liver hemangioma, which caused RUQ pain (68.8%). Group C consisted of hepatitis, gastric ulcer, appendicitis, Fitz-Hugh-Curtis syndrome (9.3%). Group D included muscular tear or no definite etiology (21.9%). Approximately 70% of total subjects had a “significant” condition. When comparing clinical relevance, according to age and presence of history with biliary stone disease, patients aged between 40 and 49 years had more “significant” diseases than those 40 years or younger (81.9% vs 58.0%, P = 0.001) (unpublished data). In the subgroup with a history of biliary stone, 44 of 48 (91.7%) had a “significant” condition, as opposed to 82 of 135 (60.7%) subjects without a history of biliary stone (P < 0.001) (unpublished data).

Bottom Line: Retrospectively, pre-contrast phase and multiphase CT findings were reviewed and the detection rate of findings suggesting disease requiring significant treatment by noncontrast CT (NCCT) was compared with cases detected by multiphase CT.Approximately 70% of total subjects had a significant condition, including 1 case of gallbladder cancer and 126 (68.8%) cases requiring intervention (122 biliary stone-related diseases, 3 liver abscesses, and 1 liver hemangioma).Biliary stones and liver space-occupying lesions were found equally on NCCT and multiphase CT.Calculated probable rates of overlooking acute cholecystitis and biliary obstruction were maximally 6.8% and 4.2% respectively.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si (IKH, YSL, JK, J-HH); Department of Internal Medicine, Wonkwang University College of Medicine, Wonkwang University Sanbon Hospital, Gunpo (IKH) and Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea (YJL, JHP).

ABSTRACT
Enhanced computed tomography (CT) is widely used for evaluating acute biliary pain in the emergency department (ED). However, concern about radiation exposure from CT has also increased. We investigated the usefulness of pre-contrast CT for differential diagnosis in middle-aged subjects with suspected biliary pain.A total of 183 subjects, who visited the ED for suspected biliary pain from January 2011 to December 2012, were included. Retrospectively, pre-contrast phase and multiphase CT findings were reviewed and the detection rate of findings suggesting disease requiring significant treatment by noncontrast CT (NCCT) was compared with cases detected by multiphase CT.Approximately 70% of total subjects had a significant condition, including 1 case of gallbladder cancer and 126 (68.8%) cases requiring intervention (122 biliary stone-related diseases, 3 liver abscesses, and 1 liver hemangioma). The rate of overlooking malignancy without contrast enhancement was calculated to be 0% to 1.5%. Biliary stones and liver space-occupying lesions were found equally on NCCT and multiphase CT. Calculated probable rates of overlooking acute cholecystitis and biliary obstruction were maximally 6.8% and 4.2% respectively. Incidental significant finding unrelated with pain consisted of 1 case of adrenal incidentaloma, which was also observed in NCCT.NCCT might be sufficient to detect life-threatening or significant disease requiring early treatment in young adults with biliary pain.

Show MeSH
Related in: MedlinePlus