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Intravital Microscopy of the Spleen: Quantitative Analysis of Parasite Mobility and Blood Flow
Published on: January 14, 2012
CT imaging of splenic sequestration in sickle cell disease
S Sheth1, C Ruzal-Shapiro, S Piomelli
1Division of Pediatric Hematology, Department of Pediatrics, Division of Hematology, College of Physicians and Surgeons of Columbia University, 622 West 168th Street, New York, NY 10032, USA. ss125@columbia.edu
Insights
Splenic sequestration crisis in children with sickle cell disease can cause severe symptoms. Contrast-enhanced CT scans reveal distinct patterns, aiding diagnosis when clinical signs are unclear.
Area of Science:
- Pediatric Hematology
- Radiology
- Medical Imaging
Background:
- Splenic sequestration crisis is a common complication in pediatric sickle cell disease.
- It ranges from mild splenomegaly to life-threatening circulatory collapse.
- Clinical diagnosis relies on spleen enlargement and a significant hemoglobin drop.
Purpose of the Study:
- To identify characteristic imaging patterns of splenic sequestration crisis using contrast-enhanced CT.
- To assess the utility of CT in diagnosing splenic sequestration when clinical presentation is ambiguous.
Main Methods:
- Retrospective review of contrast-enhanced CT scans in seven pediatric patients with suspected splenic sequestration.
- Analysis of splenic tissue appearance, including density and enhancement patterns.
Main Results:
- Two distinct CT patterns were observed: multiple peripheral non-enhancing low-density areas or large diffuse low-density areas.
- These patterns were identified in the majority of the splenic tissue in affected patients.
Conclusions:
- Contrast-enhanced CT can reveal specific patterns indicative of splenic sequestration crisis.
- Imaging provides valuable diagnostic clarification in complex or non-obvious cases, complementing clinical assessment.
Abstract:
Pooling of blood in the spleen is a frequent occurrence in children with sickle cell diseases, particularly in the first few years of life, resulting in what is termed "splenic sequestration crisis." The spectrum of severity in this syndrome is wide, ranging from mild splenomegaly to massive enlargement, circulatory collapse, and even death. The diagnosis is usually clinical, based on the enlargement of the spleen with a drop in hemoglobin level by > 2 g/dl, and it is rare that imaging studies are ordered. However, in the patient who presents to the emergency department with non-specific findings of an acute abdomen, it is important to recognize the appearance of sequestration on imaging studies. We studied seven patients utilizing contrast-enhanced CT scans and found two distinct patterns--multiple, peripheral, non-enhancing low-density areas or large, diffuse areas of low density in the majority of the splenic tissue. Although radiological imaging is not always necessary to diagnose splenic sequestration, in those situations where this diagnosis is not immediately obvious, it makes an important clarifying contribution.
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