A 75.year old woman with chronic atrial fibrillation presented to the hospital with a 2-day of colicky abdominal pain. The physical examination revealed hypoactive bowel sounds and diffuse abdominal tenderness. Laboratory tests showed a white cell count of 19,400 per cubic millimeter with 92% neutrophils, a blood urea nitrogen level of 42 mg per deciliter (15 gmol per liter) and a serum creatinine level of 3.0 mg per deciliter (267 gmol per liter). The investigation of choice would be
High-Yield Explanation
Abdominal ultrasound is a valuable investigation in patients with suspected biliary pathology and in evaluating abdominal masses. Patients with localised abdominal pain and tenderness are more likely to have a positive finding on ultrasound examination than are those with diffuse abdominal pain and tenderness Ref Davidson 23rd edition pg 677