Imaging in severe sepsis and septic shock: is early radiological identification of occult sources of infection needed?

The importance of imaging in establishing the focus of infection is recognised in current guidelines for the management of severe sepsis [1], with decisions regarding timing and modality of imaging left to the physicians' clinical judgement. In the emergency department (ED), clinical assessment combined with bedside investigations of chest X-ray (CXR) and urine dip can be used to confirm the two most common sources [2]. However, they may fail to identify occult sources of infection, such as intraabdominal collections and abscesses, the treatment of which may require alteration of empirical treatment or be refractory to antibiotic therapy alone. Further imaging is necessary to confirm the focus so that optimal treatment can be achieved.