Sonographic features of polyserositis as an adjunct to clinico - Pathological parameters in diagnosing and predicting the severity of dengue fever

Aims & objectives: we aimed to demonstrate sonographic features as an adjunct to clinico-pathological parameters in diagnosing and predicting the severity of dengue fever or dengue hemorrhagic fever. methodology: transabdominal ultrasound scanning was performed on 171 patients (93 male,78 female; age range 12-70 years,mean age 29 years) between august and december 2010,besides serological confirmation of clinical diagnosis of dengue fever. 13 patients were excluded on negative serological results. initial ultrasound scans were done on day of presentation (first 3 days of fever),with a follow up scan after one week of fever (7 th day). results: out of 158 patients,99 patients (62.65%) demonstrated sonographic features of serositis during initial scanning (first 3 days of fever). follow up scanning on 7 th day confirmed previous findings with additional findings in overall 147 patents (93%). in 11 cases (7%),we didn't demonstrate any sonographic evidence of serositis. gall bladder wall thickening was the most consistent finding in all the serologically positive cases of dengue fever,99 cases (62.65%) on initial scanning and 139 cases (88%) on follow up scan. itwas almost exclusively associated with pericholecystic edema. 72 patients demonstrated right-sided unilateral pleural effusion (45.6%) on initial scan. none had ascites or left sided pleural effusion or pericardial effusion during the first 3 days of fever. on follow-up scan (day 7),minimal to mild ascites were noted in 37 patients (23.41%),right sided pleural effusion was found in 91 (58%) and bilateral pleural effusion in 48 patients (30.37%). pericardial effusion depicted in 16 patients (10%). hepatomegaly,splenomegaly and diffused pancreatic enlargement were found in 17 (10.75%),12 (7.6%) and 9 (5.7%) cases respectively. subcapsular fluid collection in liver and spleen was found in 8 (5%) and 2 (1.2%) cases respectively,suggestive of serous fluid rather than hemorrhage. no pararenal and perirenal space fluid collections were found in any of the cases. joint effusion was demonstrated in elbow and knee joints in 2 patients (1.2%). conclusion: transabdominal ultrasound is an important diagnostic tool to clinical profile in diagnosing dendue fever early in its course compared with other modes of diagnosis before the severe form of disease is clinically apparent,thus ameliorating various complications. sonographic surveillance is necessary besides clinical and laboratory correlation due to the high risk of aggravation of dengue fever into its more severe forms.