Right upper quadrant pain is a common problem. Although it can be difficult to detect the cause, gallbladder inflammation is the most common concern. Imaging can be helpful to find the source of the pain.
Ultrasound (US) abdomen is usually appropriate as the first imaging test for those with right upper quadrant abdominal pain. Other imaging tests may also be appropriate: CT abdomen with intravenous (IV) contrast, MRI abdomen without and with IV contrast with MR cholangiopancreatography (MRCP), MRI abdomen without IV contrast with MRCP, Tc-99m cholescintigraphy (tracking a tracer given by IV from the liver into the gallbladder and small intestine), and CT abdomen without IV contrast.
With a negative or questionable US with no fever or elevated white blood cell count, MRI abdomen without and with IV contrast with MRCP, MRI without IV contrast with MRCP, or CT abdomen with IV contrast is usually appropriate as next imaging.
In someone who also has a fever and elevated white blood cell count, MRI without and with IV contrast with MRCP, CT with IV contrast, or Tc-99m cholescintigraphy is usually appropriate as the next imaging test.
In cases of gallbladder inflammation without evidence of gallstones or duct obstruction, Tc-99m cholescintigraphy is usually appropriate. CT with IV contrast, CT without IV contrast, MRI without and with IV contrast with MRCP, percutaneous cholecystostomy (placing catheter into the gallbladder), or MRI without IV contrast with MRCP may also be appropriate.