Computed tomography of the acute abdomen in patients with atrial fibrillation

OBJECTIVE: To investigate the frequency and basis of clinically relevant computed tomographic (CT) findings in patients with atrial fibrillation and acute abdominal pain. MATERIALS AND METHODS: We retrospectively identified 30 patients with atrial fibrillation referred for enhanced (n = 26) or unenhanced (n = 4) abdominal CT from our emergency department because of acute nontraumatic abdominal pain. All CT images were independently reviewed by a single reader who evaluated the studies for findings that might explain acute pain. Results were correlated with laboratory and surgical findings, clinical course and outcome, and final diagnosis. RESULTS: Eleven (37%) of the 30 patients had CT findings for abdominal pain that related to atrial fibrillation, including end-organ ischemia or infarction (n = 8, 27%) and spontaneous hemorrhage presumably related to anticoagulation (n = 3, 10%). Of the remaining patients, 5 (17%) had nonatrial fibrillation-related CT findings for abdominal pain, and 14 (47%) had no cause for abdominal pain found at CT. CONCLUSIONS: Patients with atrial fibrillation who present to CT with acute abdominal pain have a high likelihood of being found with abdominal pathology relating to their atrial fibrillation, such as arterial embolus or hemorrhage, and a lower likelihood of having more typical causes for abdominal pain. Increased awareness of the high likelihood of atrial fibrillation-related causes for abdominal pain may improve diagnoses and triage for this special and difficult population.