Right lower quadrant pain, adult
Recommended: CT Abdomen/Pelvis with IV contrast is the preferred imaging study for right lower quadrant pain, adult. First-line for evaluating right lower quadrant pain in adults.
Recommended study
CT Abdomen/Pelvis with IV contrast
First-line for evaluating right lower quadrant pain in adults. Oral contrast is generally not required. Ultrasound is first-line in pregnancy and pediatrics.
If the default doesn't apply
Pregnancy
US
Graded compression US → MRI abdomen/pelvis w/o contrast if equivocal
No contrast
Pediatrics
US
Graded compression US first
No contrast
IV contrast contraindicated
MRI
MRI abdomen/pelvis without contrast
No contrast
Watch-outs
Pregnancy and equivocal US
MRI is the next step, not CT. Coordinate with radiology for protocol.
Pearls
- An appendicolith on a non-contrast CT counts — do not re-image with contrast just to 'see better' if clinical picture fits.
- Right lower quadrant pain in young women → always include pelvic US to evaluate adnexa.