In patients with severe sepsis, a chest radiograph should be obtained because the clinical examination is unreliable for diagnosing pneumonia. Clinically occult infiltrates have been detected by routine use of chest radiography in adults who are febrile without localizing symptoms or signs and in patients who are febrile and neutropenic without pulmonary symptoms. Supine and upright or lateral decubitus abdominal films may be useful when an intra-abdominal source is suspected.
Ultrasonography is the imaging modality of choice when a biliary tract infection is suspected of being the source of sepsis.
Computed tomography (CT) is the imaging modality of choice for excluding an intra-abdominal abscess or a retroperitoneal source of infection. A CT scan of the head should be obtained when there is evidence of increased intracranial pressure (papilledema), when factors suggesting focal mass lesions (eg, focal defects, previous sinusitis or otitis, recent intracranial surgery) are present, or before lumbar puncture (LP) when meningitis is suspected.
When clinical evidence of a deep soft tissue infection exists (eg, crepitus, bullae, hemorrhage, or a foul-smelling exudate), a plain radiograph should be obtained. The presence of soft tissue gas and the spread of infection beyond the clinically detectable disease may necessitate surgical exploration.
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Stages of sepsis based on American College of Chest Physicians/Society of Critical Care Medicine Consensus Panel guidelines.
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Pathogenesis of sepsis and multiorgan failure.
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Venn diagram showing overlap of infection, bacteremia, sepsis, systemic inflammatory response syndrome (SIRS), and multiorgan dysfunction.
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Acute respiratory distress syndrome (ARDS) present in this chest x-ray (CXR) film is a common organ system affected in multiorgan failure of sepsis.
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Acute respiratory distress syndrome (ARDS) shown in this chest x-ray (CXR) film is a common complication of septic shock. Note bilateral airspace infiltration, absence of cardiomegaly, vascular redistribution, and Kerley B lines.
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Organizing phase of diffuse alveolar damage (ARDS) secondary to septic shock shows diffuse alveolar injury and infiltration with inflammatory cells.
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Organizing diffuse alveolar damage in a different location showing disorganization of pulmonary architecture.
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A high-power view of organizing diffuse alveolar damage (ARDS) shows hyperplasia of type II pneumocytes and hyaline membrane deposits.
