The role of magnetic resonance imaging in the differential diagnosis of acute right lower quadrant pain during pregnancy.

• Vol 9 • December 2007 MRI for Acute RLQ during Pregnancy Acute abdominal pain in a pregnant woman presents a significant diagnostic challenge because of the physiological and anatomic changes related to the pregnancy. Acute appendicitis complicates one of 766 pregnancies [1], but there is a long list of differential diagnoses related to the same symptoms and signs in the gravida, from normal pregnancy changes to obstetric, gynecological, gastrointestinal and genitourinary pathologies. Sonography is the primary modality to rule out appendicitis, being readily available and functioning without ionizing radiation, particularly important in pregnant women. Ultrasound involves graded compression by transducer along the border of the cecum to displace bowel loops for greater field of view and to assess compressibility of appendix (inflamed appendix will not be compressible). Nevertheless, sonography has a number of limitations: the large gravid uterus prevents compression with the transducer on the patient’s abdomen, and the appendix is displaced upward with the bowel loops by the enlarging uterus, both imposing difficulties on visualizing the appendix. Computed tomography contributes to the diagnosis of appendicitis in non-pregnant patients but is an undesirable option in pregnancy because of the radiation exposure to the fetus. Magnetic resonance imaging, on the other hand, is a modality that gives excellent resolution of the pelvic organs, with no ionizing radiation. Furthermore, it enables diagnosis of all possible causes of right lower quadrant pain [2,3]. Patient Description