Epigastric pain and sonographic assessment of the pancreas in dengue hemorrhagic fever

Abstract

Purpose This study reports the sonographic features of the pancreas in children who have dengue hemorrhagic fever (DHF) with epigastric pain, evaluates pancreatic abnormalities as the source of this pain, and relates sonographic findings, DHF status, and serum levels of amylase and lipase. Methods Over 3.5 years, real‐time sonographic examination of the pancreas was prospectively performed in 148 children (age range, 5 months–14 years) who had DHF with epigastric pain. The DHF diagnosis was confirmed by serologic examination and viral isolation. Results Of the 142 children included in this study, 72 had mild DHF (grade I or II) and 70 had severe DHF (grade III or IV). An enlarged pancreas was found in 41 patients (29%), 10 (14%) of whom had mild DHF and 31 (44%) of whom had severe DHF. The pancreas was hyperechoic relative to the liver in 36 patients (25%), isoechoic in 98 (69%), and hypoechoic in 8 (6%). Conclusions The majority of patients with DHF and epigastric pain do not have an enlarged pancreas, different echogenicity of the pancreas compared with the liver, or a dilated pancreatic duct. Thus, pathologic changes of the pancreas cannot be the only cause of epigastric pain in DHF patients. Increased serum levels of amylase and lipase are commonly seen in patients with severe DHF and an enlarged pancreas. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:257–259, 1998.

Biochemical and radiological markers as predictors of dengue severity in children admitted in a tertiary care hospital

“…In children with dengue fever with warning signs, raised LDH and CPK levels can be attributed to skeletal muscle damage. 5,[10][11][12][13][14][15] In addition, liver damage is a frequent problem in dengue that can also be related to increased levels of LDH. 10,11 Our analysis suggests that these biomarkers can predict a more severe form of dengue and could be indicators of early tissue injury in the acute phase of dengue infection.…”

Acute pancreatitis complicating dengue hemorrhagic fever

“…All children with mild DHF had a normal-sized pancreas and in all 10 severe cases children with increased serum levels of amylase and lipase had an enlarged pancreas (7) . In a previous study, 14 out of 328 cases of DHF/dengue shock syndrome (DSS) had an acute abdomen; causes included acute cholecystitis (n = 10), nonspecific peritonitis (n = 3), and acute appendicitis (n = 1); none had acute pancreatitis (8) .…”

Atypical Manifestations of Dengue Fever – Where Do We Stand Today?

“…Ultrasound abdomen is characterized by enlarged pancreas and elevated serum amylase and lipase levels [10,11]. There are few case reports of febrile diarrhea in dengue patients as well [5].…”