My CT says “no acute findings” — why do I still feel pain?

A CT report that says “no acute findings” can be confusing if you still feel pain. It means the radiologist did not see a new, urgent problem on the scan that needs immediate treatment. Examples of acute findings include active bleeding, a ruptured appendix, a bowel obstruction, or a large kidney stone causing blockage.
It does not mean that nothing is wrong. It means the CT scan did not show a dangerous emergency at the time it was performed.

What “No Acute Findings” Means on a Radiology Report

Radiology reports use the word acute to describe problems that are sudden, severe, and time-sensitive. When your CT says no acute findings, it usually means:

• No obvious emergent cause of pain was seen

• No major infection or severe inflammation was identified

• No internal injury stood out on the images

Sometimes the report may say “no CT findings to explain the patient’s symptoms.” This is a statement about the scan, not a dismissal of your pain.

What CT Scans Are Good at Detecting

CT imaging is excellent for evaluating many urgent conditions. Depending on the scan type and whether contrast was used, CT can often detect:

• Appendicitis and diverticulitis

• Kidney stones and urinary blockage

• Bowel obstruction or perforation

• Internal bleeding and trauma

• Large tumors or advanced cancers

• Abscesses and significant fluid collections

• Certain vascular emergencies

CT is fast and powerful, but it cannot see everything.

Normal CT but Ongoing Pain: Common Reasons

It is very common for patients to have real pain even when a CT scan looks normal. There are several reasons for this.

The CT May Have Been Done Too Early

Some conditions take time to fully develop. Early appendicitis, early infection, or early inflammation may not yet look abnormal. If symptoms worsen later, repeat testing may show changes.

Some Problems Are Too Small or Subtle for CT

Very small abnormalities may fall below the detection threshold of CT. Examples include tiny stones, early inflammatory changes, or subtle bowel abnormalities.

Lack of IV Contrast Can Matter

Some CT scans are done without contrast, especially for kidney stones. While appropriate, non-contrast CT can miss certain conditions.

Functional Disorders Do Not Appear on CT

Many painful conditions affect how an organ works rather than how it looks. These are called functional disorders and often cause normal imaging. Examples include:

• Irritable bowel syndrome

• Acid reflux or gastritis

• Constipation with cramping

• Pelvic floor dysfunction

These conditions are real and painful, even when CT is normal.

Mild or Microscopic Inflammation

CT may miss inflammation that is mild or limited to the inner lining of organs. Examples include:

• Early colitis

• Mild inflammatory bowel disease

• Small stomach or duodenal ulcers

Other tests such as endoscopy, blood work, or stool studies may be more helpful.

Muscle, Spine, and Abdominal Wall Pain

Pain often comes from muscles, joints, or nerves rather than internal organs. CT may not clearly show:

• Abdominal muscle strain

• Rib or cartilage related pain

• Spine problems referring pain to the abdomen

• Small hernias that reduce when lying down

These are common reasons for pain with a normal CT scan.

Nerve-Related Pain Often Has Normal Imaging

Nerve pain can be sharp, burning, or electric and does not appear on CT. Causes include:

• Shingles before a rash appears

• Pinched nerves from the spine

• Entrapment of small abdominal wall nerves

Clinical exam and symptom patterns are often more important than imaging in these cases.

Pelvic Pain May Need Ultrasound or MRI

For pelvic symptoms, CT is often not the best test. Ultrasound or MRI may better detect:

• Ovarian cysts

• Endometriosis

• Fibroid-related pain

• Early pelvic inflammatory disease

The best imaging test depends on symptoms and anatomy.

Gallbladder disease Can Be Missed on CT

Right upper abdominal pain, especially after eating, is often related to the gallbladder. Ultrasound is usually better than CT for detecting gallstones and gallbladder inflammation.

“Non-Acute” Findings Can Still Be Important

CT reports often list findings that are not emergencies but may still matter, such as:

• Small hernias

• Degenerative spine changes

• Kidney stones

• Enlarged lymph nodes

These findings need to be interpreted in the context of your symptoms.

Questions to Ask After a Normal CT

If your pain continues, consider asking your doctor:

• Was contrast used, and if not, could a repeat with contrast help diagnose a suspected condition?

• What conditions does CT rule out well in my case?

• Are there non-acute findings that could explain my pain?

• Would ultrasound, MRI, or endoscopy be more appropriate?

When to Seek Care Again Despite a Normal CT

Go back for urgent care if you develop:

• Worsening or severe pain

• Fever

• Persistent vomiting

• Blood in stool or vomit

• Chest pain or shortness of breath

• Fainting or confusion

• worsening of any condition that you have

A normal CT does not override concerning symptoms.

Conclusion

“No acute findings” on CT means no emergency was visible at the time of the scan, not that your pain is imaginary or unimportant. Many causes of pain do not show up on CT or require different imaging tests. If symptoms persist or change, further evaluation should be performed by your doctor.

References

https://www.radiologyinfo.org/en/info/all-about-your-radiology-report

https://www.radiologyinfo.org/en/info/abdomen

https://www.mayoclinic.org/symptoms/abdominal-pain/basics/when-to-see-doctor/sym-20050728