Puerperal sepsis

Case contributed by Dr Chris O'Donnell

Presentation

Foetal death in utero with sepsis. Delayed vaginal delivery with infected liquor. Now severe hypotension with fever and ongoing foul vaginal discharge.

Patient Data

Age: 35 years
Gender: Female
CT

Enlarged (post parturition) uterus with heterogeneous enhancement and swelling in the myometrium and endometrium especially at the fundus suggestive of localized sepsis.  Full hand of CT hypotension complex ie "black spleen" with virtually no enhancement in arterial and portal venous phases (HU of 49 to 58), "shock pancreas" with patchy enhancement and edema in the adjacent mesentery, "shock liver" with reduced enhancement and periportal edema, "shock bowel" with dilatation and mural edema with increased enhancement and "black kidneys" showing markedly reduced enhancement especially in the arterial phase.  Note the splenic and renal arteries are patent on the angiogram thus reduced parenchymal enhancement is at an arteriole/capillary level. Aorta and IVC are not collapsed or slit-like.

Case Discussion

Septic shock can produce an identical CT picture to severe hypovolemia shock (ie CT hypotension complex) except in sepsis, the aorta is not reduced in caliber and the IVC is not slit-like as blood volume is normal.  In this case, there is infection in the endometrium (endometritis) extending into the myometrium secondary to prolonged foetal death.  The common organism that causes such sepsis is Group A beta-hemolytic Streptococcus pyogenes.  If septic shock ensues, it is often fatal.

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Case information

rID: 41863
Published: 24th Dec 2015
Last edited: 25th Nov 2019
Inclusion in quiz mode: Included

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