Hyperdense Interventricular Septum Sign: Radiomarker for Early Identification of Hidden Hypovolemia

Abstract

Introduction: Hypovolemia is a critical clinical condition that requires early diagnosis to avoid severe complications. The hyperdense interventricular septum sign on computed tomography is an emerging radiological finding that could serve as an early marker of non-obvious hypovolemia.

Objective: To evaluate the diagnostic utility of the hyperdense interventricular septum sign on computed tomography for the early detection of hypovolemia in critically ill patients.

Methods: A prospective observational study was conducted at the Regional Hospital of San Vicente, Cape Verde, with 120 adult patients with clinically suspected hypovolemia. The presence of the sign on computed tomography was assessed and correlated with clinical, hemodynamic, and biochemical parameters. Sensitivity, specificity, predictive values, and interobserver agreement were calculated.

Results: The sign was observed in 38.3% of patients. Patients with the sign had significantly lower mean arterial pressure, higher heart rate, elevated serum lactate, hemoconcentration, and oliguria (p < 0.001). The sensitivity and specificity of the sign were 78% and 85%, respectively, with an area under the ROC curve of 0.82. Interobserver agreement was excellent (kappa = 0.89).

Conclusions: The hyperdense interventricular septum sign on computed tomography is a reliable, reproducible radiological marker with good diagnostic performance for the early detection of hypovolemia, complementing clinical evaluation in critically ill patients.