Point-of-care ultrasound in the diagnosis of a patient with subclinical congestion
Keywords:
diabetic nephropathy, point-of-care testing, ultrasonographyAbstract
Introduction: Subclinical congestion is defined as the accumulation of fluids within blood vessels, tissues, or organs without obvious clinical manifestations. It is diagnosed by point-of-care ultrasound.
Objective: To demonstrate the importance of ultrasound in recognizing the manifestations of plasma leakage due to dengue from those of subclinical congestion due to diabetic nephropathy at the point of care.
Clinical Case: A 21-year-old male patient with a history of type 1 diabetes mellitus was admitted with a diagnosis of dengue. On the fifth day, ultrasound examination revealed bilateral pleural effusion, free abdominal fluid, and a dilated inferior vena cava. Based on these findings, it was decided to transfer him to the intensive care unit. He was evaluated using point-of-care ultrasound and diagnosed with subclinical global congestion. Treatment with diuretics was prescribed, which resulted in the resolution of the congestion.
Conclusions: Point-of-care ultrasound allows differentiation between ultrasound findings typical of complicated dengue and those associated with subclinical congestion states secondary to other causes.
Downloads
References
1. Velasco Malagón S, Acosta-Gutiérrez E, Atilio Nuñezramos J, Salinas S, Mora Pabón G. Subclinical Congestion Evaluated by Point of Care Ultrasound (POCUS) at Discharge Predicts Readmission in Patients with Acute Heart Failure: Prognostic Cohort Study [Internet]. POCUS J. 2024; 9(2):125-32. DOI: 10.24908/pocus.v9i2.17709
2. Martens P. Detecting subclinical congestion in stage A/B pre-heart failure: a glimpse into the future? [Internet]. Eur J Heart Fail. 2021; 23(11):1841-3. DOI: 10.1002/ejhf.2366
3. Núñez J, de la Espriella R, Rossignol P, Voors AA, Mullens W, Metra M, et al. Congestion in heart failure: a circulating biomarker-based perspective. A review from the Biomarkers Working Group of the Heart Failure Association, European Society of Cardiology [Internet]. Eur J Heart Fail. 2022; 24(10):1751-66. DOI: 10.1002/ejhf.2664
4. Rodríguez-Espinosa D, Guzman-Bofarull J, De La Fuente-Mancera JC, Maduell F, Broseta JJ, Farrero M. Multimodal Strategies for the Diagnosis and Management of Refractory Congestion. An Integrated Cardiorenal Approach [Internet]. Front Physiol. 2022; 13(1):913580. DOI: 10.3389/fphys.2022.913580
5. Naddaf N, Dianati Maleki N, Goldschmidt ME, Kalogeropoulos AP. Point of Care Ultrasound (POCUS) in the Management of Heart Failure: A Narrative Review [Internet]. J Pers Med. 2024; 14(7):766. DOI: 10.3390/jpm14070766
6. Koratala A, Romero-González G, Soliman-Aboumarie H, Kazory A. Unlocking the Potential of VExUS in Assessing Venous Congestion: The Art of Doing It Right [Internet]. Cardiorenal Med. 2024; 14(1):350-74. DOI: 10.1159/000539469
7. Kharat A, Tallaa F, Lepage MA, Trinh E, Suri RS, Mavrakanas TA. Volume Status Assessment by Lung Ultrasound in End-Stage Kidney Disease: A Systematic Review [Internet]. Can J Kidney Health Dis. 2023; 10(1):20543581231217853. DOI: 10.1177/20543581231217853
8. Campos-Sáenz de Santamaría A, Albines Fiestas ZS, Crespo-Aznarez S, Esterellas-Sánchez LK, Sánchez-Marteles M, Garcés-Horna V, et al. VExUS Protocol Along Cardiorenal Syndrome: An Updated Review [Internet]. J Clin Med. 2025; 14(4):1334. DOI: 10.3390/jcm14041334
9. Assavapokee T, Rola P, Assavapokee N, Koratala A. Decoding VExUS: a practical guide for excelling in point-of-care ultrasound assessment of venous congestion [Internet]. Ultrasound J. 2024; 16(1):48. DOI: 10.1186/s13089-024-00396-z
10. Galindo Dávila JD, Gomez Sandoval DM, Ardila Gómez IJ, Salgado García DM. Ecografía en dengue: 10 hallazgos claves [Internet]. Acta Colomb Cuid Intensivo. 2024; 24(4):404-12. DOI: 10.1016/j.acci.2024.05.011
11. Narula J, Chandrashekhar Y, Braunwald E. Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation [Internet]. JAMA Cardiol. 2018; 3(4):346-50. DOI: 10.1001/jamacardio.2018.0001
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Luis Fong Pantoja, Francisco Alberto Sánchez Licea, Kenia Álvarez Fong
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who have publications with this Journal accept the following terms:
- The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
- The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
- Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.
