Karın Ağrılarında Görüntüleme İlkeleri: Tomografi
Özet
Karın ağrısı acil servise başvuruda bulunan hastaların ciddi bir yoğunluğunu oluşturan aynı zamanda suistimal edilen bir konudur. Karın ve pelvik bölgede tanısal görüntüleme yöntemlerinden biri olan bilgisayarlı tomografi (BT) bazı klinikler tarafından computerized axial tomography (CAT) olarak da isimlendirilir. Karın bölgesinde BT için birçok endikasyon bulunmakla birlikte hızlı, ağrısız, zaman zaman girişim gerektiren bu yöntemin güvenilirliği son derece yüksektir. Klasik tıp her ne kadar muayene ve görüntüleme yöntemlerini bazı adımlar ile ilerlemesini istese de ülkemizde gerek hastaların sabırsızlığı gerekse hekimlerin sonuca hızlı ilerleme istekleri , hekimleri sıralama ve kılavuzların dışına taşarak daha sonuç odaklı tetkiklere başvurdukları bilinmektedir. Bu bölümde karın ağrısının temel sebepleri, ağrı mekanizmaları, laboratuvar tetkik sıralamalarına değinilmeden vakalar eşliğinde incelenecek, görülme sıklığına göre ele alınacak ve görseller ile desteklenecektir.
Abdominal pain is a major and often abused symptom that causes a significant number of emergency department visits. Computed tomography (CT), a diagnostic imaging method for the abdominal and pelvic regions, is also referred to as computerized axial tomography (CAT) by some clinics. While there are many indications for abdominal CT scans, this method is rapid, painless, and sometimes requires minimal intervention, yet its reliability is extremely high. Although classical medicine advocates for gradual progression of examination and imaging methods, in our country, due to both patients' impatience and physicians' desire for rapid results, it is known that doctors often deviate from established procedures and guidelines, resorting to more results-oriented diagnostic methods. This section will examine the underlying causes of abdominal pain, pain mechanisms, and laboratory test sequences, without going into detail, but will focus on case studies, addressing them according to their frequency and supporting the findings with visuals.
Referanslar
Cartwright SL, Knudson MP. Diagnostic imaging of acute abdominal pain in adults. Am Fam Physician. 2015 Apr 1;91(7):452-9. PMID: 25884745.
Expert Panel on Gastrointestinal Imaging:; Scheirey CD, Fowler KJ, Therrien JA, Kim DH et al. ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain. J Am Coll Radiol. 2018 Nov;15(11S):S217-S231. doi: 10.1016/j.jacr.2018.09.010. PMID: 30392591.
Rud B, Vejborg TS, Rappeport ED et al. Computed tomography for diagnosis of acute appendicitis in adults. Cochrane Database Syst Rev. 2019 Nov 19;2019(11):CD009977. doi: 10.1002/14651858.CD009977.pub2. PMID: 31743429; PMCID: PMC6953397.
D'Souza D, Sharma R, Le L, et al. Abdominal aortic aneurysm. Reference article, Radiopaedia.org (Accessed on 17 Feb 2026) https://doi.org/10.53347/rID-826
Tsetse C, Chaudhry SR, Jabi F et al. Perforated cecal diverticulitis with CT diagnosis and medical management. Radiol Case Rep. 2018 Oct 4;14(1):30-35. doi: 10.1016/j.radcr.2018.08.030. PMID: 30305862; PMCID: PMC6176041.
Ghosh S, Alhamshari A, Prajapati P et al. Role of computed tomography in imaging of endometriosis. Abdom Radiol (NY). 2025 Oct;50(10):4886-4900. doi: 10.1007/s00261-025-04907-x. Epub 2025 Mar 27. PMID: 40146309.
Ghafoor S, Hoppe AT, Lange M et al. Computed tomography for evaluation of abdominal wall hernias-what is the value of the Valsalva maneuver? Hernia. 2024 Oct;28(5):1709-1718. doi: 10.1007/s10029-024-03036-6. Epub 2024 Jun 14. PMID: 38874659; PMCID: PMC11449955.
Lanzetta MM, Masserelli A, Addeo G et al. Internal hernias: a difficult diagnostic challenge. Review of CT signs and clinical findings. Acta Biomed. 2019 Apr 24;90(5-S):20-37. doi: 10.23750/abm.v90i5-S.8344. PMID: 31085971; PMCID: PMC6625567.
Gaillard F, Walizai T, Knipe H, et al. Abdominal hernia. Reference article, Radiopaedia.org (Accessed on 17 Feb 2026) https://doi.org/10.53347/rID-827
Tsili AC, Varkarakis I, Pasoglou V, et al. CT of the urinary tract revisited. Eur J Radiol. 2023 Mar;160:110717. doi: 10.1016/j.ejrad.2023.110717. Epub 2023 Jan 30. PMID: 36773595.
El-Ghar, M.A.; Farg, H.; Sharaf, D.E.; El-Diasty, T. CT and MRI in Urinary Tract Infections: A Spectrum of Different Imaging Findings. Medicina 2021, 57, 32. https://doi.org/10.3390/medicina57010032
Fidler J, Paulson EK, Layfield L. CT evaluation of acute cholecystitis: findings and usefulness in diagnosis. AJR Am J Roentgenol. 1996 May;166(5):1085-8. doi: 10.2214/ajr.166.5.8615248. PMID: 8615248.
Dumitrescu A, Acute cholecystitis (CT and ultrasound). Case study, Radiopaedia.org (Accessed on 17 Feb 2026) https://doi.org/10.53347/rID-152087
Kotha VK, Khandelwal A, Saboo SS,et al. Radiologist's perspective for the Meckel's diverticulum and its complications. Br J Radiol. 2014 May;87(1037):20130743. doi: 10.1259/bjr.20130743. Epub 2014 Feb 17. PMID: 24611767; PMCID: PMC4075535.
Olson MC, Fletcher JG, Nagpal P, et al. Mesenteric ischemia: what the radiologist needs to know. Cardiovasc Diagn Ther. 2019 Aug;9(Suppl 1):S74-S87. doi: 10.21037/cdt.2018.09.06. PMID: 31559155; PMCID: PMC6732105.
Dhanda S, Quek ST, Ting MY, et al. CT features in surgically proven cases of ovarian torsion-a pictorial review. Br J Radiol. 2017 Oct;90(1078):20170052. doi: 10.1259/bjr.20170052. Epub 2017 Jun 27. PMID: 28511550; PMCID: PMC5853358.
Al-Khafaji, M.Q.; Al-Smadi, M.W., et al. Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review. J. Clin. Med. 2024, 13, 3199. https://doi.org/10.3390/jcm13113199
Minordi LM, Larosa L, Berte G, et al. CT of the acute colonic diverticulitis: a pictorial essay. Diagn Interv Radiol. 2020 Nov;26(6):546-551. doi: 10.5152/dir.2020.19645. PMID: 33180020; PMCID: PMC7664754.
Park MJ, Lim JS. Computed tomography enterography for evaluation of inflammatory bowel disease. Clin Endosc. 2013 Jul;46(4):327-66. doi: 10.5946/ce.2013.46.4.327. Epub 2013 Jul 31. PMID: 23964329; PMCID: PMC3746137.
Frager D. Intestinal obstruction role of CT. Gastroenterol Clin North Am. 2002 Sep;31(3):777-99. doi: 10.1016/s0889-8553(02)00026-2. PMID: 12481731.
Brizi MG, Perillo F, Cannone F,et al. The role of imaging in acute pancreatitis. Radiol Med. 2021 Aug;126(8):1017-1029. doi: 10.1007/s11547-021-01359-3. Epub 2021 May 12. PMID: 33982269; PMCID: PMC8292294.
Mous A, Rasuli B, Ibrahim D, et al. Acute pancreatitis. Reference article, Radiopaedia.org (Accessed on 18 Feb 2026) https://doi.org/10.53347/rID-849
Referanslar
Cartwright SL, Knudson MP. Diagnostic imaging of acute abdominal pain in adults. Am Fam Physician. 2015 Apr 1;91(7):452-9. PMID: 25884745.
Expert Panel on Gastrointestinal Imaging:; Scheirey CD, Fowler KJ, Therrien JA, Kim DH et al. ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain. J Am Coll Radiol. 2018 Nov;15(11S):S217-S231. doi: 10.1016/j.jacr.2018.09.010. PMID: 30392591.
Rud B, Vejborg TS, Rappeport ED et al. Computed tomography for diagnosis of acute appendicitis in adults. Cochrane Database Syst Rev. 2019 Nov 19;2019(11):CD009977. doi: 10.1002/14651858.CD009977.pub2. PMID: 31743429; PMCID: PMC6953397.
D'Souza D, Sharma R, Le L, et al. Abdominal aortic aneurysm. Reference article, Radiopaedia.org (Accessed on 17 Feb 2026) https://doi.org/10.53347/rID-826
Tsetse C, Chaudhry SR, Jabi F et al. Perforated cecal diverticulitis with CT diagnosis and medical management. Radiol Case Rep. 2018 Oct 4;14(1):30-35. doi: 10.1016/j.radcr.2018.08.030. PMID: 30305862; PMCID: PMC6176041.
Ghosh S, Alhamshari A, Prajapati P et al. Role of computed tomography in imaging of endometriosis. Abdom Radiol (NY). 2025 Oct;50(10):4886-4900. doi: 10.1007/s00261-025-04907-x. Epub 2025 Mar 27. PMID: 40146309.
Ghafoor S, Hoppe AT, Lange M et al. Computed tomography for evaluation of abdominal wall hernias-what is the value of the Valsalva maneuver? Hernia. 2024 Oct;28(5):1709-1718. doi: 10.1007/s10029-024-03036-6. Epub 2024 Jun 14. PMID: 38874659; PMCID: PMC11449955.
Lanzetta MM, Masserelli A, Addeo G et al. Internal hernias: a difficult diagnostic challenge. Review of CT signs and clinical findings. Acta Biomed. 2019 Apr 24;90(5-S):20-37. doi: 10.23750/abm.v90i5-S.8344. PMID: 31085971; PMCID: PMC6625567.
Gaillard F, Walizai T, Knipe H, et al. Abdominal hernia. Reference article, Radiopaedia.org (Accessed on 17 Feb 2026) https://doi.org/10.53347/rID-827
Tsili AC, Varkarakis I, Pasoglou V, et al. CT of the urinary tract revisited. Eur J Radiol. 2023 Mar;160:110717. doi: 10.1016/j.ejrad.2023.110717. Epub 2023 Jan 30. PMID: 36773595.
El-Ghar, M.A.; Farg, H.; Sharaf, D.E.; El-Diasty, T. CT and MRI in Urinary Tract Infections: A Spectrum of Different Imaging Findings. Medicina 2021, 57, 32. https://doi.org/10.3390/medicina57010032
Fidler J, Paulson EK, Layfield L. CT evaluation of acute cholecystitis: findings and usefulness in diagnosis. AJR Am J Roentgenol. 1996 May;166(5):1085-8. doi: 10.2214/ajr.166.5.8615248. PMID: 8615248.
Dumitrescu A, Acute cholecystitis (CT and ultrasound). Case study, Radiopaedia.org (Accessed on 17 Feb 2026) https://doi.org/10.53347/rID-152087
Kotha VK, Khandelwal A, Saboo SS,et al. Radiologist's perspective for the Meckel's diverticulum and its complications. Br J Radiol. 2014 May;87(1037):20130743. doi: 10.1259/bjr.20130743. Epub 2014 Feb 17. PMID: 24611767; PMCID: PMC4075535.
Olson MC, Fletcher JG, Nagpal P, et al. Mesenteric ischemia: what the radiologist needs to know. Cardiovasc Diagn Ther. 2019 Aug;9(Suppl 1):S74-S87. doi: 10.21037/cdt.2018.09.06. PMID: 31559155; PMCID: PMC6732105.
Dhanda S, Quek ST, Ting MY, et al. CT features in surgically proven cases of ovarian torsion-a pictorial review. Br J Radiol. 2017 Oct;90(1078):20170052. doi: 10.1259/bjr.20170052. Epub 2017 Jun 27. PMID: 28511550; PMCID: PMC5853358.
Al-Khafaji, M.Q.; Al-Smadi, M.W., et al. Evaluating Imaging Techniques for Diagnosing and Drainage Guidance of Psoas Muscle Abscess: A Systematic Review. J. Clin. Med. 2024, 13, 3199. https://doi.org/10.3390/jcm13113199
Minordi LM, Larosa L, Berte G, et al. CT of the acute colonic diverticulitis: a pictorial essay. Diagn Interv Radiol. 2020 Nov;26(6):546-551. doi: 10.5152/dir.2020.19645. PMID: 33180020; PMCID: PMC7664754.
Park MJ, Lim JS. Computed tomography enterography for evaluation of inflammatory bowel disease. Clin Endosc. 2013 Jul;46(4):327-66. doi: 10.5946/ce.2013.46.4.327. Epub 2013 Jul 31. PMID: 23964329; PMCID: PMC3746137.
Frager D. Intestinal obstruction role of CT. Gastroenterol Clin North Am. 2002 Sep;31(3):777-99. doi: 10.1016/s0889-8553(02)00026-2. PMID: 12481731.
Brizi MG, Perillo F, Cannone F,et al. The role of imaging in acute pancreatitis. Radiol Med. 2021 Aug;126(8):1017-1029. doi: 10.1007/s11547-021-01359-3. Epub 2021 May 12. PMID: 33982269; PMCID: PMC8292294.
Mous A, Rasuli B, Ibrahim D, et al. Acute pancreatitis. Reference article, Radiopaedia.org (Accessed on 18 Feb 2026) https://doi.org/10.53347/rID-849
