]> 2026-07-31T05:34:28+00:00 WBR0003 0 en Lateral decubitus chest x-ray. Plain upright chest x-ray. As a general rule, chest X-ray is the best initial radiographic test for any pulmonary complaint. In the case of gastric perforation, upright chest x-ray is a rapid diagnostic tool that will show free air under the diaphragm. Abdominal CT scan While abdominal CT scan is the most accurate test for gastric perforation, it is not the best initial test due to the urgent nature of the disease. Abdominal CT is the most accurate test to diagnose intrabdominal inflammatory diseases such as diverticulitis and pancreatitis. Oral contrast is critical when performing abdominal CTs, as it helps to outline the bowel against other organs that may become pressed against it. Abdominal X-ray Abdominal X-ray is not the best initial radiographic test for suspected perforation of the stomach or bowel. Instead, a plain upright X-ray is more appropriate. Abdominal X-ray will often fail to detect free air under the diaphragm generated by a perforation, especially in tall people. Abdominal X-ray is the appropriate imaging test for suspected cases of bowel obstruction or ileus. Emergency esophagogastroduodenoscopy While the perforated ulcer may require surgical or endoscopic treatment, emergency gastroduodenoscopy is not the best initial diagnostic test in this patient. Internal medicine Anonymous (Edited by Will Gibson and Alison Leibowitz) A 56-year-old man presents to the urgent care clinic for constant epigastric pain. He reports a history of gastrointestinal ulcers, which felt similar to the patient's current presentation. He recalls taking one week of a 2-week course of medication several years ago after which his ulcers resolved. While waiting for preliminary laboratory results, the patient's condition rapidly deteriorates. He suddenly complains of severe pain in his upper abdomen and turns pale. His blood pressure acutely rises to 150/110 mmHg and his heart rate increases to 120 bpm. What is the optimal imaging study for diagnosing the most likely condition? B Gastrointestinal 2020-10-27T23:01:53Z 2459150.4596412 WBR0003