Correct!
4. More than one of the above
Both chest radiography and abdominal ultrasound are reasonable initial tests for perform when a patient in the Emergency Room presents with chest and abdominal pain. Chest CT is probably premature at this point, and may be reserved for more specific clinical indications or for further evaluation when initial chest radiography is abnormal and the clinical presentation remains unclear.
The patient underwent right upper quadrant ultrasound (images not shown) that was interpreted as unremarkable; no gallbladder wall thickening or biliary duct dilation was noted and no gallstones were seen. The patient then underwent nuclear medicine biliary scintigraphy with hepatobiliary iminodiacetic acid (“HIDA” scan; images not shown) which showed “sluggish” tracer uptake by the gallbladder, interpreted as potentially representing cholecystitis.
Which of the following represents an appropriate next step for the patient’s management? (Click on the correct answer to be directed to the third of thirteen pages)