Ebook ABC of sepsis: Part 2
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Ebook ABC of sepsis: Part 2
CHAPTER 9The Role of Imaging in SepsisMorgan CleasbyCkiod Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UKOVERVIEW. Modem maging t Ebook ABC of sepsis: Part 2techniques are important in locating the source of sepsis. A chest radogrcphEbook ABC of sepsis: Part 2
patients following abdominal surgery It also shows intrapulmcnary and intracranial abscesses. However. It invo’ves a hgh dose of rádatioo•Magnetic reCHAPTER 9The Role of Imaging in SepsisMorgan CleasbyCkiod Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UKOVERVIEW. Modem maging t Ebook ABC of sepsis: Part 2omyelitis However. it is not suitable for unstable patients and there are a number of contraindications•Image-guided techniques are important for diagnostic aspraben and therapeutic dramage of abscesses and infected boiow visceraIntroductionIn the patient with sepsis, history taking and examination Ebook ABC of sepsis: Part 2will suggest the likely source in many cases. Imaging may help to confirm the primary site or to search for it if not clinically apparent. This chapteEbook ABC of sepsis: Part 2
r will discuss the various imaging modalities used to assess the likely site of origin of septic illness, including their relative strengths and weaknCHAPTER 9The Role of Imaging in SepsisMorgan CleasbyCkiod Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UKOVERVIEW. Modem maging t Ebook ABC of sepsis: Part 2es or infected hollow viscera.Whenever sepsis is suspected clinically, this should be highlighted to the radiologist when requesting imaging investigations. This will enable the appropriate examination to be performed, within asuitably urgent timeframe, it is recommended that indices of the severity Ebook ABC of sepsis: Part 2 of sepsis should be included in the radiological referral, such as the white cell count, evidence of raised inflammatory markers and evidence of renaEbook ABC of sepsis: Part 2
l impairment, particularly if iodinated intravenous contrast is likely to be used. If the patient is critically ill, the critical care team should be CHAPTER 9The Role of Imaging in SepsisMorgan CleasbyCkiod Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UKOVERVIEW. Modem maging t Ebook ABC of sepsis: Part 2ives an overview of the imaging modalities that can l»e used in the investigation of sepsis. These techniques will be discussed in turn.Plain radiographyThe usefulness of plain radiographic examination should not be overlooked. A chest radiograph (CXR) should be considered a first-line investigation Ebook ABC of sepsis: Part 2 when a patient presents with sepsis. It may show the primary source of sepsis (such as pneumonic consolidation, pleural empyema or pulmonary abscess)Ebook ABC of sepsis: Part 2
, or secondaryTable 9.1 Major indications for the different imaging modalties in sepsis.ModalityPrincipal indicationsMain radiographyexit lungs, pleurCHAPTER 9The Role of Imaging in SepsisMorgan CleasbyCkiod Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UKOVERVIEW. Modem maging t Ebook ABC of sepsis: Part 2collectionsCTAbdcmerVpefvts: 8owel. retropentoneum Post-operatrve Chest lung abscesses, mediastinum Mead Cerebral, extradural abscesses Sinuses, mastcxdsMR1Bran: As per CT Spine Extradural abscesses, discrtis Bone: OsteomyelitisNuclear medic meWhile cell scan Occdt source of infection Gallium scan: Ebook ABC of sepsis: Part 2Pyrexia of unknown ongĩnABC of Srpfif. Edited by Ron Daniell and Tim Nutbeam. © 2010 by Hbckwll Publishing. ISBN: 978-1-450141 194-5.CXR. chest radiogEbook ABC of sepsis: Part 2
raph; AXR. abdominal radiograph; CT. computerized tomography. MRI. magnetic resonance imaging42I(a)(b)Figure 9.1 (a) A chest radog-aph >i an intr.^^noCHAPTER 9The Role of Imaging in SepsisMorgan CleasbyCkiod Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UKOVERVIEW. Modem maging t Ebook ABC of sepsis: Part 2m the same patient coníirmitỴi that these opacities represent carttles. typical of staphylococcal abscesses.signs. Examples of the latter include left atrial enlargement and pulmonary oedema secondary to mitral valve incompetence from infective endocarditis, or an elevated hemidiaphragm and basal at Ebook ABC of sepsis: Part 2electasis secondary to a subphrenic abscess. Multiple peripheral lung cavities may suggest the haematogenous spread of staphylococcal sepsis from a peEbook ABC of sepsis: Part 2
ripheral superficial abscess, or the possibility of intravenous drug abuse (Figure 9.1).Other radiographic examinations have more specific indicationsCHAPTER 9The Role of Imaging in SepsisMorgan CleasbyCkiod Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UKOVERVIEW. Modem maging t Ebook ABC of sepsis: Part 2 are likely to alter management. If an abdominal ultrasound or computerized tomography (CT) examination is to be requested, the AXR need not be performed. An AXR may be useful to consider the presence of renal calculi in urological sepsis, although not all calculi are radio-opaque, and these patient Ebook ABC of sepsis: Part 2s are likely to require an ultrasound or CT scan of the renal tract. The presence of air in the biliary tree (pneumobilia) raises the possibility of bEbook ABC of sepsis: Part 2
iliary sepsis (Figure 9.2) although the most common cause nowadays is a previous sphincterotomy. Portal venous gas secondary to massive intra-abdominaCHAPTER 9The Role of Imaging in SepsisMorgan CleasbyCkiod Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UKOVERVIEW. Modem maging t Ebook ABC of sepsis: Part 2estruction in the spine in discitis, although magnetic resonance imaging (MR1) is much more sensitive to early changes in these conditions.Figure 9.2 A plain abdominal radiograph showing gas in the wail of the gallbladder in the right upper quadrant in a diabetic patient with sepsis and right upper Ebook ABC of sepsis: Part 2quad-ant pain: the diagnosis is emphysematous cholecystitisUltrasoundCHAPTER 9The Role of Imaging in SepsisMorgan CleasbyCkiod Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UKOVERVIEW. Modem maging tCHAPTER 9The Role of Imaging in SepsisMorgan CleasbyCkiod Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UKOVERVIEW. Modem maging tGọi ngay
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