Sonographic evaluation of gallbladder-wall thickening in hemorrhagic feverwith renal syndrome: prediction of disease severity

Purpose. Gallbladder-wall thickening (GBWT) frequently occurs in patients w ith hemorrhagic fever with renal syndrome (HFRS), an acute infectious disea se caused by hantaviruses. HFRS is manifested by fever, hemorrhage, renal f ailure, and in many cases gastrointestinal symptoms, such as abdominal pain and tenderness. The clinical significance of GBWT in HFRS has not been rep orted. The purpose of this study was to investigate the incidence of GBWT a nd the relationship between GBWT and the severity of HFRS. Methods. We retrospectively reviewed the medical records and sonograms of 6 8 patients with HFRS (47 males and 21 females, with an age range of 10-76 y ears) who underwent abdominal sonography in the acute stage of the disease. We measured the gallbladder-wall thickness on the sonograms and reviewed o ther sonographic and radiographic findings. Clinical factors that reflect t he severity of HFRS were compared between the patients with GBWT (defined a s thickness of 4 mm or more) and those without GBWT. Results. Of the 68 patients, 29 (43%) had GBWT, which was even and diffuse in all cases. The patients with GBWT had a significantly lower mean platele t count and serum albumin level and significantly higher serum aspartate am inotransferase and serum lactate dehydrogenase levels than did the patients without GBWT. In addition, the incidence of renal failure requiring hemodi alysis and the incidences of ascites and pleural effusion were higher in th e patients with GBWT than in those without GBWT. Five patients died of HFRS ; all 5 had GBWT (p = 0.011 for comparison with patients without GBWT). Conclusions. Our results suggest that the sonographic measurement of gallbl adder-wall thickness during the acute stage of HFRS is useful for determini ng the severity of HFRS. (C) 2001 John Wiley & Sons, Inc.