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Abdomen » Hepatobiliary
Acute Acalculous Cholecystitis and Ascites (Dengue Fever Stage III)
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Author(s) :
Leandro Fernandez, MD
 
Presentation 5 year old female patient, 5 days with high fever, pain in right hypochondrium, headache, retro-ocular and muscular pain, nausea and dehydration. The patient lives in a tropical region of South America.
 
 
 
Caption: Fig 1. Oblique views, right hypochondrium
Description: This dual image in longitudinal and transverse planes reveals gallbladder wall thickening with a small amount of free fluid along the anterior wall. No lithiasis is observed.
 
 
 
Caption: Fig 2 Longitudinal view of right kidney
Description: This image demonstrates a fluid collection in Morrison's Pouch, at the interface between Gerota's fascia of the kidney and the liver.
 
 
 
Caption: Fig 3 Longitudinal view, left iliac quadrant.
Description: Fig 3: This image shows a free fluid collection in the left iliac fossa.
 
Differential Diagnosis
  1. Acute Acalculous Cholecystitis
  2. Intra-abdominal hemorrhage
  3. Peri-renal abscess
 
Final Diagnosis

Acute Acalculous Cholecystitis and Ascites

(Dengue Fever Stage III)

 
Discussion

Dengue is an endemic and epidemic disease in almost all of the tropical regions and in most subtropical regions. With an important incidence in Africa, it is more predominant in South-East Asia, the Pacific Islands and Central and South America. Dengue (DF) and dengue hemorrhagic fever (DHF) are caused by one of four closely related, but antigenically distinct, virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4), of the genus Flavivirus. Infection with one of these serotypes provides immunity to only that serotype for life, so persons living in a dengue-endemic area can have more than one dengue infection during their lifetime. DF and DHF are primarily diseases of tropical and sub tropical areas, and the four different dengue serotypes are maintained in a cycle that involves humans and the Aedes mosquito. The Aedes aegypti is the most important vector.

Ultrasound techniques have been used for the evaluation of adults and children suffering from dengue. Depending on the disease’s severity, the ultrasonographic findings may vary from mild ascites, hepatomegaly and thickening of gallbladder walls in Stage I-II to these findings and pleural effusion, pancreatic enlargement, peri- or para-renal collections and pericardial effusion in Stage III-IV.

 
Case References
  1. Fernandez L. “Dengue Fever” in Manual of Diagnostic Ultrasound in Infectious Tropical Diseases. Lutz HT Gharbi HA. Springer. Berlin 2006 p.117-119
  2. Sharma N et al. Dengue fever related acalculous cholecystitis in a North Indian tertiary care hospital. J Gastroenterol Hepatol.  2006; 21(4):664-7 
  3. Venkata Sai PM et al. Role of ultrasound in dengue fever. Br J Radiol.  2005; 78(929):416-8
 
Technical Details

ATL HDI 5000 ultrasound system with a C5-2 (5 to 2 Mhz) curved linear transducer

 
Follow Up

Serological test confirmed an acute infection by Dengue virus. (Dengue-blot and IG-M)

 
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