Septic shock due to puerperal fever: CT findings

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

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 ehancement in arterial and portal venous phases (HU of 49 to 58), "shock pancreas" with patchy enhancement and oedema in the adjacent mesentery, "shock liver" with reduced enhancement and periportal oedema, "shock bowel" with dilatation and mural oedema 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 indentical CT picture to severe hypovolaemia shock (ie CT hypotension complex) except in sepsis, the aorta is not reduced in calibre 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 haemolytic Streptococcus pyogenes.  If septic shock ensues, it is often fatal.

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Case Information

rID: 41863
Case created: 23rd Dec 2015
Last edited: 12th Sep 2016
Inclusion in quiz mode: Included

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