Imaging and intervention in patients with acute right upper quadrant disease

Area of Science:

• Radiology
• Gastroenterology
• Interventional Radiology

Background:

• Acute right upper quadrant pain often stems from inflammatory conditions like liver abscesses, cholangitis, and cholecystitis.
• Ultrasound (US) is the preferred initial imaging modality due to its diagnostic accuracy, accessibility, and bedside capabilities.

Purpose of the Study:

• To review the role of imaging and interventional procedures in managing acute inflammatory right upper quadrant conditions.
• To outline therapeutic strategies based on imaging findings and patient presentation.

Main Methods:

• Review of current literature and clinical practice guidelines for US, CT, and interventional radiology in hepatobiliary and gallbladder diseases.
• Analysis of diagnostic yield and therapeutic outcomes for various imaging-guided interventions.

Main Results:

• US is effective for diagnosing liver abscesses, cholangitis, and cholecystitis; CT is reserved for complex cases.
• Percutaneous drainage offers high cure rates for large liver abscesses (75-90%).
• Endoscopic and percutaneous cholangiography significantly reduce mortality in acute cholangitis; percutaneous drainage is an option if endoscopic procedures fail.
• Percutaneous cholecystostomy is effective for high-risk patients with acute cholecystitis, and percutaneous cholecystectomy can be definitive for acalculous cholecystitis.

Conclusions:

• Ultrasound plays a pivotal role in the diagnosis and management of acute inflammatory right upper quadrant pain.
• Interventional radiology techniques, including percutaneous drainage and cholangiography, are essential for treating complex cases and improving patient outcomes.
• Tailored therapeutic strategies based on imaging findings and disease characteristics are crucial for effective management.