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Right lower quadrant (RLQ) pain is a common clinical presentation in children, and accurate clinical diagnosis remains challenging given that this nonspecific presentation is associated with numerous surgical and nonsurgical conditions. The broad differential diagnosis varies by patient age and sex. Importance considerations in selection of a diagnostic imaging strategy include tests' sequencing, performance, and cost. This article provides a comprehensive narrative review on the diagnostic imaging of RLQ pain in children and adolescents, including discussion of the complementary roles of ultrasound, CT, and MRI; description of key imaging findings based on the available evidence; and presentation of salient differential diagnoses. Subspecialized pediatric emergency medicine and surgical perspectives are also provided as further clinical insight on this common, but often challenging, scenario. Finally, the current status of imaging of RLQ pain in children and adolescents is summarized based on expert consensus.