Effective utilization of imaging in patients with severe acute pancreatitis requires an understanding of the subtypes and complications of pancreatitis. Imaging, particularly computed tomography, can confirm the diagnosis of pancreatitis, identify local complications, offer prognostic information, and guide therapeutic interventions. Conventional radiography, ultrasound, endoscopic retrograde cholangiopancreatography, and magnetic resonance imaging have important adjunctive roles in the evaluation and treatment of patients with severe acute pancreatitis. Early identification of pancreatic parenchymal necrosis and areas of infection facilitates timely and appropriate management of these often critically ill patients. Imaging-guided interventions can provide definitive or adjunctive treatment for fluid collections, biliary and pancreatic duct obstruction, and vascular complications.