An on-call-focused systematic reporting guide for comprehensively assessing organs, bowel, vessels, peritoneum, and retroperitoneum on routine abdomen and pelvis CT.
RadPhrases Editorial Team6 min read
An on-call-focused systematic reporting guide for comprehensively assessing organs, bowel, vessels, peritoneum, and retroperitoneum on routine abdomen and pelvis CT.
Scope The following is a general assessment sequence for routine adult abdomen and pelvis CT. Dedicated trauma, pancreas, liver, adrenal, urography, enterography, colonography, and vascular CT protocols require separate interpretation and reporting approaches.
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Abdomen and pelvis CT includes many organs, and it is easy to miss a second urgent finding while focusing on the clinical question. A fixed review sequence helps ensure that solid organs, bowel, vessels, peritoneum, and bones are all included in the report.
This checklist is designed particularly to support the on-call approach of “identify the acute finding first, then complete the entire examination.”
1. Protocol and clinical context
☐ Read the indication. Pain location, fever, trauma, malignancy, postoperative status, and laboratory findings alter the priorities of assessment.
☐ Identify contrast administration and phase. Noncontrast, arterial, portal venous, or delayed phase determines the limits of lesion characterization and vascular assessment.
☐ Is oral/enteric contrast present? Understand its advantages and limitations for assessing the bowel lumen and anastomoses.
☐ Confirm coverage. The imaged area should extend from the diaphragmatic domes to the pelvic floor as needed to answer the clinical question.
☐ Compare prior examinations. This is important for changes in masses, collections, obstruction, hydronephrosis, and vascular measurements.
2. Rapid emergency survey
☐ Free intraperitoneal air. Check beneath the diaphragms, along the liver surface, and in the anterior abdomen using appropriate settings, including lung windows.
☐ Active bleeding or hemoperitoneum. Assess high-attenuation fluid, contrast extravasation, and hematomas across phases.
☐ Bowel obstruction and ischemia. Look for dilated loops, a transition point, closed-loop configuration, mural perfusion abnormality, mesenteric edema, and pneumatosis.
☐ Vascular emergency. Within the limits of the protocol, assess for aneurysm rupture, dissection, arterial or venous occlusion, and impaired organ perfusion.
☐ Acute inflammation or perforation. Prioritize signs of complications in processes such as appendicitis, diverticulitis, cholecystitis, pancreatitis, and postoperative leak.
3. Lower chest and diaphragm
☐ Lung bases. Check for consolidation, pleural fluid, nodules, and peripheral opacities that may be related to embolism.
☐ Imaged heart and pericardium. Note findings such as substantial fluid or cardiomegaly that could affect management.
☐ Diaphragm and hiatuses. Assess for hernia, defect, and adjacent collections.
4. Liver, gallbladder, and biliary tree
☐ Liver size, contour, and attenuation. Is there steatosis, cirrhotic morphology, or heterogeneous perfusion?
☐ Focal lesions. Describe location, size, appearance across phases, and interval change; respect the characterization limits of a single phase.
☐ Portal and hepatic veins. Assess patency, thrombosis, collaterals, and perfusion changes.
☐ Gallbladder. Check for stones, wall thickening, distention, and surrounding inflammation.
☐ Biliary tree. Is there intrahepatic or extrahepatic dilatation or a stone or mass explaining the level of obstruction?
5. Spleen, pancreas, and adrenal glands
☐ Spleen. Assess size and look for infarction, traumatic injury, or a focal mass.
☐ Stomach and duodenum. Is there wall thickening, distention, a sign of ulcer/perforation, or gastric outlet obstruction?
☐ Small bowel. Assess caliber, wall thickness, enhancement, contents, transition point, and mesenteric relationships.
☐ Colon. Review for diverticula, inflammation, mass, fecal burden, and obstruction.
☐ Appendix. Locate it whenever possible regardless of the indication; assess caliber, wall, surrounding inflammation, and complications.
☐ Anastomoses and stoma. Check for leak, stricture, obstruction, and parastomal hernia.
8. Peritoneum, mesentery, retroperitoneum, and lymph nodes
☐ Free or loculated fluid. Assess distribution, attenuation, wall, and gas to consider infection or hemorrhage.
☐ Mesentery. Review for edema, inflammatory fat stranding, torsion, nodules, and vascular relationships.
☐ Retroperitoneum. Survey the psoas and perirenal spaces for hematoma, fibrosis, mass, or collection.
☐ Lymph nodes. State region, short-axis size, morphology, and change from prior imaging.
☐ Peritoneal surfaces. Assess nodularity, thickening, and omental changes in the oncologic context.
9. Vessels
☐ Aorta and major branches. Assess caliber, aneurysm, dissection, thrombus, and atherosclerosis.
☐ Mesenteric vessels. Check patency, stenosis or occlusion, venous thrombosis, and correlation with bowel findings.
☐ Portal venous system. Is there thrombosis or collateral formation in the portal, splenic, or superior mesenteric veins?
☐ Iliac vessels and IVC. Assess thrombosis, compression, filter placement, and surgical changes.
10. Pelvic organs, hernias, bones, and soft tissues
☐ Uterus/adnexa or prostate/seminal vesicles. Assess for an obvious mass or acute finding according to age, sex, and clinical context.
☐ Inguinal, femoral, and ventral hernias. Check contents and signs of obstruction or strangulation.
☐ Abdominal wall. Review for collections, hematoma, surgical wounds, and subcutaneous emphysema.
☐ Bones. Assess the spine, pelvis, and proximal femora on bone windows for fracture, destruction, sclerotic foci, and compression deformity.
11. Impression
Place the acute, management-changing finding first, together with its anatomical location and complications.
When multiple abnormalities are present, prioritize the one related to the clinical question; chronic incidental findings should not obscure the impression.
If a lesion cannot be characterized because a dedicated protocol is absent, state the limitation and recommend appropriate further imaging only when necessary.
Express interval change clearly and, when possible, quantitatively.
Communicate urgent findings directly according to the local policy.
Communication of critical findings
The report alone is not sufficient for an acute abdominal emergency Perforation, active bleeding, ruptured aneurysm, mesenteric ischemia, closed-loop obstruction, organ torsion, major postoperative leak, and other time-sensitive findings require timely, documented communication with the clinical team.
12. Commonly overlooked areas
Lung bases
Appendix
Both adrenal glands
Entire course of both ureters
Mesenteric vessels and portal venous system
Inguinal and femoral hernias
Psoas muscles and retroperitoneum
Spine and pelvis on bone windows
Postoperative anastomoses and regions around drains
ACR Practice Parameter for Communication of Diagnostic Imaging Findings, Revised 2025. Report components and principles for nonroutine/urgent communication. Source (opens in a new tab)
ACR-SABI-SAR-SPR Practice Parameter for CT of the Abdomen and Pelvis, Revised 2021. Framework for abdomen and pelvis CT performance and documentation. Source (opens in a new tab)
ACR-SPR Practice Parameter for Performing and Interpreting Diagnostic CT, Revised 2022. General CT interpretation, documentation, and safety principles. Source (opens in a new tab)
Clinical use note
This content is educational and is not patient-specific medical advice. Every phrase, template, classification result, and recommendation must be verified and adapted by a physician using the complete examination, clinical context, current guidelines, and institutional protocol.
Turn the checklist into a report template
Use this sequence as an editable RadPhrases template and verify it against the images in every case.
