Patterns of Gall Bladder Wall Thickening in Dengue Fever: A Mirror of the Severity of Disease

Abstract

Background Dengue fever is a major public health problem with an increased incidence in recent years. Gall bladder wall thickening has been reported as one of the most common findings in dengue fever. There is a paucity of literature regarding the various patterns of gall bladder wall thickening in dengue fever and their significance in predicting the severity of disease. Methodology and Significant Findings Out of 93 seropositive patients included in the study, 54 patients with dengue fever had gall bladder wall thickening. 4 patterns of gall bladder wall thickening are demonstrated in this study. A uniform echogenic pattern in 20 patients, striated or tram track pattern in 11 patients, an asymmetric pattern in 2 patients and a honeycombing pattern in 21 patients. The range of patterns of wall thickening included normal wall thickening or uniform echogenic wall thickening in DF without warning signs, a striated or tram track pattern, and a honeycomb pattern in severe DF. Serial ultrasound done on consecutive alternate days revealed a change in the pattern of gall bladder wall thickening according to the severity of disease. Conclusion The present study revealed 4 distinct patterns of gall bladder wall thickening. The uniform echogenic pattern was found to be more prevalent in dengue fever without warning signs, while the honeycomb pattern was found to be more prevalent in severe dengue fever. A change in the pattern of gall bladder wall thickening on subsequent serial ultrasound can predict the severity of the disease.

Hyperferritinemia and Gallbladder Wall Oedema as Early Markers of a Severe Dengue Infection in a Developing Nation.

“…These ndings were in accordance with a similar study done by Michels M et al in which severe dengue patients had a gallbladder wall thickening of 3-7 mm and the non-severe cases had a mean value of 3.6 mm [15]. Jitendra et al had a similar study with mean GB wall thickness of 3.32-4.95 mm in non-severe dengue cases and a mean value 8.8 mm among severe dengue cases [16]. Our ndings were consistent with the clinical deterioration of patients with non-severe dengue on the 3rd − 4th day of fever to severe dengue as the days progressed.…”

“…Clinically it is di cult to determine leakage of plasma and quite often serum hematocrit is used as an adjunct to detect signi cant plasma leak [15]. Gallbladder wall thickening due to signi cant plasma leakage is one of the commonest ndings in dengue fever [16]. A few studies indicate that ultrasonography plays an important role in detecting patients who progress to a critical phase by measuring the thickness of the gallbladder wall [17][18][19].…”

Letter to Editor Commenting on “Patterns of Gall Bladder Wall Thickening in Dengue Fever” – Reply

“…In our study, serial ultrasounds were performed on consecutive alternate days, which revealed change in the pattern of gall bladder wall thickening according to the severity of disease, clearly establishing gall bladder wall thickening due to dengue fever only [1].…”

Acute Hepatic Failure-An Unusual Complication of Dengue Fever in Adults

“…In GB wall oedema there is preservation of mucosal echogenicity with hypoechoic appearance of muscle layer. There are 4 patterns of GB wall thickening described in Dengue fever [6]. They are A) Uniform wall thickening; B) Tram -track pattern; C) Asymmetric wall thickening; D) Honeycomb pattern.…”