Role of ultrasonography in diagnosing dengue shock syndrome in patients presenting with symptoms of acute abdominal pain

Background: Dengue shock syndrome (DSS) can present with acute abdominal symptoms, often mimicking surgical emergencies such as appendicitis, particularly in pediatric patients. Early and accurate differentiation is crucial to avoid unnecessary interventions. This study aimed to evaluate the role of ultrasonography (USG) in diagnosing DSS among children presenting with acute abdominal pain. Methods: This cross-sectional study was conducted in the Department of Radiology, Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh, from November 2022 to November 2024. This study included 82 pediatric patients who tested negative for the rapid NS1 antigen test and presented with acute abdominal symptoms suggestive of appendicitis. Results: The most common age group was 7–11 years (37.80%) and males comprised 58.54% of the study population. Abdominal pain was universally present (100%), followed by fever (95.12%) and vomiting (65.85%). DSS was confirmed in 35 patients (42.68%). Key ultrasonographic findings included free peritoneal fluid (54.88%), thickened bowel wall (52.44%), inflamed appendix (50%), collapsed IVC (42.68%) and gallbladder wall thickening (36.59%). Laboratory abnormalities such as thrombocytopenia (58.54%) and leukopenia (47.56%) were common in DSS cases. USG showed strong diagnostic performance with a sensitivity (88.6%), specificity (85.1%), PPV (81.6%) and NPV (90.9%). The overall diagnostic accuracy of USG for DSS was 86.6%. Conclusions: Ultrasonography is a valuable, non-invasive diagnostic tool with high sensitivity and specificity in identifying dengue shock syndrome among pediatric patients presenting with acute abdominal pain. Incorporating USG into the diagnostic approach can aid in early recognition of DSS, minimize misdiagnosis and prevent unnecessary surgical interventions.