Abdomen and Pelvis CT Reporting System: From the Acute Abdomen to Oncologic Follow-up
A practical reporting guide that combines contrast phase, the gastrointestinal tract, solid organs, and emergency complications within one review sequence.
RadPhrases Editorial Team6 min read
REPORTING SYSTEMATICS / ABDOMEN
A practical reporting guide that combines contrast phase, the gastrointestinal tract, solid organs, and emergency complications within one review sequence.
The first question on abdomen and pelvis CT: Which phase and clinical question am I assessing?
Abdomen and pelvis CT is used for many different indications, including acute abdominal pain, trauma, malignancy staging and follow-up, infection, urinary symptoms, and postoperative complications. Noncontrast, arterial, portal venous, nephrographic, and delayed phases do not depict the same diseases with equal sensitivity. The technique section is therefore clinical information that defines the limits of interpretation.
Before reviewing the examination, confirm oral or intravenous contrast administration, phase timing, scan coverage, prior surgery, and any current stoma, drain, or catheter. Particularly in emergency studies, prioritize findings that answer the clinical question while still performing a fixed second survey of the entire abdomen and pelvis.
Related calculators
Browse the other checklists, phrase sets, and systematic approaches in this topic.
Acute danger survey. On the first pass, search for findings that would rapidly alter management, including free intraperitoneal air, active hemorrhage, signs of bowel ischemia, high-grade obstruction, rupture, a large collection, and urinary obstruction.
Liver and portal system. Assess size, contour, parenchyma, focal lesions, and the portal and hepatic veins to the extent permitted by the phase and indication.
Gallbladder and bile ducts. Assess calculi, the wall, surrounding inflammation, intrahepatic and extrahepatic duct caliber, and postsurgical changes.
Spleen and pancreas. Interpret size, parenchyma, focal lesions, inflammation, peripancreatic fluid, and ductal appearance together with the phase.
Adrenal glands. Assess nodules, enlargement, hemorrhage, or infiltration and compare with prior examinations.
Kidneys, ureters, and urinary bladder. Assess parenchymal enhancement, calculi, hydronephrosis, masses, perinephric changes, ureteral course, and the bladder wall. Noncontrast and contrast-enhanced phases have different strengths.
Gastrointestinal tract. Assess the stomach, small bowel, colon, and, according to the clinical context, appendix for caliber, wall, enhancement, surrounding fat, a transition point, and complications.
Peritoneum, mesentery, and retroperitoneum. Assess free fluid, free air, collections, implants, mesenteric edema or signs of torsion, and retroperitoneal abnormalities.
Lymph nodes and vessels. Assess nodal station, short-axis diameter, distribution, and change; review the aorta, iliac vessels, and, according to the clinical question, mesenteric vessels.
Pelvic organs. Assess the uterus and adnexa or prostate and seminal vesicles in the context of age, sex, surgical history, and examination phase.
Abdominal wall, muscles, and bones. Search for hernias, collections, hematomas, soft-tissue masses, acute fractures, osseous destruction, or metastatic lesions.
Lung bases. Report pleural fluid, consolidation, nodules, and other important thoracic findings while acknowledging the limited coverage.
Do not dismiss the bowel as “normal” in one line The gastrointestinal tract requires its own search pattern, particularly in the acute abdomen. From the stomach to the rectum, assess bowel caliber, wall, contents, transition point, mesentery, vessels, and surrounding fat together. If the appendix is not visualized, state this in conjunction with the clinical context and secondary findings.
Build findings into a causal chain in the acute abdomen
Instead of simply stating “dilated small-bowel loops,” assess the degree of dilation, transition point, distal collapse, closed-loop features, wall enhancement, mesenteric edema, free fluid, and signs of perforation together. The likely level of obstruction and suspected complications are more useful for clinical management in the impression.
Similarly, in inflammatory processes such as pancreatitis, diverticulitis, or appendicitis, search for collections, free air, vascular complications, and effects on adjacent organs in addition to the primary-organ finding. Rather than merely naming the diagnosis, the report should communicate disease extent and complications.
Measurement and comparison discipline in oncologic follow-up
In oncologic examinations, it is important to measure the same lesions in the same plane using a similar technique, clearly identify new lesions, and reflect changes in nontarget disease in the report. Response criteria may vary by tumor type and treatment; follow the institution’s oncologic reporting standard.
Rather than labeling every small size change as progression or response, consider measurement variability and differences in phase and technique. In the impression, prioritize the overall direction of disease burden, new organ involvement, and complications.
Abdomen and pelvis CT report template framework
This template should be divided into separate versions for the acute abdomen, stone protocol, and oncologic follow-up:
INDICATION: [Clinical question] COMPARISON: [Date and examination] TECHNIQUE: [Contrast, phases, oral contrast, reconstructions, limitations] FINDINGS: Liver and portal system: [Assessment] Gallbladder and bile ducts: [Assessment] Spleen and pancreas: [Assessment] Adrenal glands: [Assessment] Kidneys, ureters, and urinary bladder: [Assessment] Gastrointestinal tract and appendix: [Assessment] Peritoneum/mesentery/retroperitoneum: [Fluid, air, collection, implant] Lymph nodes and vessels: [Assessment] Pelvic organs: [Assessment] Abdominal wall, bones, and lung bases: [Important findings] IMPRESSION: 1. [Primary diagnosis or finding answering the clinical question] 2. [Complication, extent, or second important finding] 3. [Recommendation appropriate to guidelines and clinical context, if needed]
Common mistakes
Making a definitive exclusion statement for solid-organ or vascular disease without stating the contrast phase.
Focusing only on the suspected organ in an acute abdomen and failing to complete the survey for free air, ischemia, obstruction, and collections.
Dismissing the bowel in a single line as “unremarkable.”
Failing to state the side, level, and degree of obstruction for a urinary finding.
Measuring prior lesions in different planes during oncologic follow-up or omitting a new lesion from the impression.
Routinely overlooking the pelvic organs or lung bases.
Making a recommendation without reflecting a technical limitation in the findings.
The impression: diagnosis, extent, complication
The abdomen and pelvis CT impression should prioritize three questions: What is the main diagnosis or most likely explanation? What is the extent of disease? Is there a complication that changes urgent management? This triad removes unnecessary detail from the impression, particularly in the acute abdomen and oncologic patients.
If incidental findings are included in the impression, prioritize them according to clinical significance and need for follow-up. Follow-up recommendations should be consistent with current guidelines, the patient’s risk profile, and prior imaging; automatic template recommendations must be verified by a specialist.
Quick pre-sign-off check
Are contrast administration and phases correctly described? Was the initial survey for free air, active hemorrhage, ischemia, obstruction, and collections completed? Were all solid organs, the gastrointestinal tract, peritoneum, vessels, and pelvic structures assessed? Were the lung bases and bones checked? Is meaningful interval change clear? Does the impression communicate diagnosis, extent, and complications in that order?
Sources
ACR Practice Parameter for Communication of Diagnostic Imaging Findings (Revised 2025) — Core report components, the impression section, and principles for nonroutine communication. Source (opens in a new tab)
RSNA RadReport Reporting Templates — A resource for standardized, consistent, and comprehensive reporting templates. Source (opens in a new tab)
ESR paper on structured reporting in radiology—update 2023 — Current framework and implementation principles for structured reporting. Source (opens in a new tab)
Structured reporting in radiology: a systematic review — A systematic assessment of the evidence on structured reporting. Source (opens in a new tab)
ACR–SABI–SAR–SPR Practice Parameter for CT of the Abdomen and CT of the Pelvis — Performance, scope, and documentation of CT of the abdomen and pelvis. Source (opens in a new tab)
ACR–SPR Practice Parameter for Performing and Interpreting Diagnostic Computed Tomography — General technical and reporting principles for diagnostic CT. 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.
Apply the system with a ready-to-edit template
Open an examination-specific framework in RadPhrases, adapt it to the findings, and verify it before signing.
