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ACR Appropriateness Criteria® Acute Left Upper Quadrant Pain.

, Sahar Soleimani1, Ihab R Kamel2

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Journal of the American College of Radiology : JACR
|November 5, 2025
PubMed
Summary

Left upper quadrant (LUQ) abdominal pain assessment is challenging due to nonspecific symptoms and low exam agreement. This guideline addresses acute LUQ pain with suspected splenomegaly, recommending CT or ultrasound for diagnosis.

Keywords:
AUCAppropriate Use CriteriaAppropriateness CriteriaCTacute abdominal painleft upper quadrant (LUQ)splenomegalyultrasound (US)

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Area of Science:

  • Radiology
  • Gastroenterology
  • Emergency Medicine

Background:

  • Acute abdominal pain is a frequent emergency department complaint.
  • Left upper quadrant (LUQ) pain presents unique diagnostic challenges due to low physical exam agreement and nonspecific symptoms.
  • LUQ pain can originate from the spleen, LUQ infections, or referred pain from abdominal organs.

Purpose of the Study:

  • To provide evidence-based guidelines for evaluating acute left upper quadrant (LUQ) abdominal pain, particularly when splenomegaly is suspected.
  • To address diagnostic strategies for LUQ pain with fever and unspecified causes.
  • To outline appropriate imaging modalities based on clinical presentation.

Main Methods:

  • Systematic analysis of peer-reviewed medical literature.
  • Application of established methodology principles like Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
  • Utilizing the RAND/UCLA Appropriateness Method for evaluating imaging procedures.

Main Results:

  • Computed tomography (CT) of the abdomen and pelvis with contrast is generally appropriate for broad pathology detection.
  • Ultrasound of the abdomen is a suitable alternative for initial imaging in patients with suspected splenomegaly.
  • Recommendations are based on expert consensus when literature evidence is limited.

Conclusions:

  • Diagnostic imaging, including CT and ultrasound, plays a crucial role in assessing acute LUQ pain.
  • The American College of Radiology Appropriateness Criteria provide a framework for appropriate imaging selection.
  • Expert opinion is valuable in formulating recommendations for complex or rare presentations.