Role of Ultrasonography (“Honeycomb Sign”) in Early Detection of Dengue Hemorrhagic Fever

Abstract

Aim: This study was conducted to evaluate the early, specific ultrasonographic (USG) findings in clinically suspected dengue hemorrhagic fever (DHF) along with its prognostic value. Methods: From May 2009 to June 2012, 20 patients were referred with high-grade fever and abdominal pain. All the patients underwent immediate abdominal USG. A specific change – “Honeycomb” pattern in the thickened gallbladder (GB) wall (mostly in the fundal area) – on USG suggested the diagnosis of DHF, which was subsequently confirmed by serology in all patients. Treatment was stated on the bases of USG findings before the positive serology report. After starting treatment the USG on the 3rd day showed reduction in GB wall thickening, which was almost cleared by the 7th day in clinically improving patients. Results: All 20 patients had type-2 dengue fever, i.e., DHF Grades I and II, as confirmed after USG by platelet count and serologic tests. USG features included a much-thickened GB wall in all the patients, but showing a “Honeycomb” pattern (proposed as Sachar and Sunder’s sign) in 19 patients (95%), multilayered (laminated/onion peel) in 1 patient (5%), ascites in 15 patients (75%), splenomegaly in 8 patients (40%), and pleural effusion in 14 patients (70%). (Pleural effusion was either right-sided or bilateral, but never alone on the left side.) Conclusions: Abdominal emergency USG can be used as a first-line imaging modality in patients with suspected DHF to detect early signs that are suggestive of the disease prior to obtaining serologic confirmation test results, especially in a dengue fever epidemic area. Also, reducing GB wall thickness can be used as a prognostic sign in cases of DHF.