A patient has right upper quadrant pain, fever and a positive Murphy's sign. Which is the best initial imaging test?
Answer and explanation
Correct answer: D. Ultrasound of the abdomen
- Step 1: The presentation suggests biliary disease such as acute cholecystitis. Step 2. Ultrasound is quick, avoids radiation and detects gallstones, wall thickening and a dilated bile duct. Answer: Ultrasound of the abdomen. Why not the others: Plain films miss most gallstones. CT pulmonary angiography looks for emboli. A lumbar spine MRI is irrelevant.
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