title: Sonographic evaluation of gallbladder-wall thickening in hemorrhagic fever with renal syndrome: prediction of disease severity.
abstract: OBJECTIVE
  Gallbladder-wall thickening (GBWT) frequently occurs in patients with hemorrhagic fever with renal syndrome (HFRS), an acute infectious disease caused by hantaviruses. HFRS is manifested by fever, hemorrhage, renal failure, and in many cases gastrointestinal symptoms, such as abdominal pain and tenderness. The clinical significance of GBWT in HFRS has not been reported. The purpose of this study was to investigate the incidence of GBWT and the relationship between GBWT and the severity of HFRS.
  
  
  METHODS
  We retrospectively reviewed the medical records and sonograms of 68 patients with HFRS (47 males and 21 females, with an age range of 10-76 years) who underwent abdominal sonography in the acute stage of the disease. We measured the gallbladder-wall thickness on the sonograms and reviewed other sonographic and radiographic findings. Clinical factors that reflect the severity of HFRS were compared between the patients with GBWT (defined as 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 platelet count and serum albumin level and significantly higher serum aspartate aminotransferase and serum lactate dehydrogenase levels than did the patients without GBWT. In addition, the incidence of renal failure requiring hemodialysis and the incidences of ascites and pleural effusion were higher in the 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 gallbladder-wall thickness during the acute stage of HFRS is useful for determining the severity of HFRS.
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul 137-701, South Korea.
authors.forename: Y O
authors.initials: YO
authors.lastname: Kim
authors.forename: K A
authors.initials: KA
authors.lastname: Chun
authors.forename: J Y
authors.initials: JY
authors.lastname: Choi
authors.forename: S A
authors.initials: SA
authors.lastname: Yoon
authors.forename: C W
authors.initials: CW
authors.lastname: Yang
authors.forename: K T
authors.initials: KT
authors.lastname: Kim
authors.forename: B K
authors.initials: BK
authors.lastname: Bang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging* / Q000473:pathology; D018063:Hantaan virus / Q000472:pathogenicity*; D006480:Hemorrhagic Fever with Renal Syndrome / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography