Dengue: Are We Underestimating Severity? What Imaging Exams Reveal

Dengue remains a significant global public health threat, and its high incidence in Brazil results in serious complications such as capillary leak syndrome. Despite advances in care, the persistence of discrepancies between laboratory results and clinical or radiological findings can lead to underestimation of the true severity of the disease. This retrospective study was designed to evaluate the frequency of imaging exams ‒ including X-Ray, ultrasound, and tomography ‒ and to identify the main findings on these exams in patients diagnosed with dengue, in order to reveal relevant patterns for diagnosis and management. Cross-sectional study, approved by an ethics committee. For data collection, 644 anonymized electronic medical records of patients aged 18 years or older with dengue diagnosis confirmed by NS1 or IgM tests were used, a convenience sample. The variables investigated focused on the performance of imaging exams and the specific findings of each exam. Statistical analysis was processed using the software JAMOVI 2.3.28 Solid, with a significance level of p<0.05. Radiological findings were extracted, and the frequency of both imaging exams and their main findings was determined. The analysis revealed: 145 (equivalent to 22.5% of visits) underwent radiography, 83 (12.9%) ultrasound, and 92 (14.3%) tomography. Regarding the most prominent findings, on chest radiography, pleural effusion was observed in 15% of the exams performed, while signs of pulmonary congestion were identified in 10%. On ultrasound, gallbladder wall thickening stood out as a frequent finding, present in 40% of positive cases, accompanied by other findings such as ascites and hepato/splenomegaly (10%). On tomography, pleural and pericardial effusion was the most common finding, detected in 25% of exams. This study provides the frequency of radiological findings in patients seen for dengue. The presence of these radiological findings, however, highlights possible discrepancies with the current clinical classification of the Ministério da Saúde (A to D), suggesting a potential underestimation of the true severity of the disease. Prospective multicenter studies are suggested. Such studies would be crucial to validate the observed correlations.