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Radiological Patterns in Sickle Cell Disease Patients with Acute Chest Syndrome: Are There Age-Related Differences?
Abdulaziz Mohammad Al-Sharydah1, Mohammed Alshahrani2, Bander Aldhaferi1
1Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia.
Insights
Acute chest syndrome (ACS) in sickle cell disease patients shows similar lung findings in children and adults. However, adults more frequently present with extrapulmonary complications, and low hemoglobin predicts ACS.
Area of Science:
- Hematology
- Pulmonary Medicine
- Radiology
Background:
- Acute chest syndrome (ACS) is a significant cause of morbidity and mortality in sickle cell disease (SCD).
- Diagnostic delays in ACS can occur due to age-related differences in imaging presentations.
- Understanding these differences is crucial for timely diagnosis and management of SCD patients.
Purpose of the Study:
- To delineate pulmonary and extrapulmonary imaging findings in SCD patients diagnosed with ACS.
- To compare these findings between adult and pediatric patient cohorts.
- To identify potential imaging biomarkers for ACS in SCD.
Main Methods:
- Retrospective analysis of 150 SCD patients admitted with ACS between January and June 2015.
- Categorization of patients into adult and pediatric groups.
- Comparison of pulmonary, extrapulmonary, radiological (digital radiography, CT), and laboratory findings between the groups.
Main Results:
- 116 patients (163 ACS episodes) met inclusion criteria; 60% were adults.
- Lung consolidation was the most common pulmonary finding in both groups.
- Extrapulmonary findings like avascular necrosis and cardiomegaly were more frequent in adults (P < 0.05).
- Pediatric patients exhibited lower hemoglobin and oxygen tension (P < 0.01).
Conclusions:
- Pulmonary manifestations of ACS in SCD are similar across pediatric and adult age groups.
- Extrapulmonary findings are more prevalent in adult SCD patients with ACS.
- Low hemoglobin and oxygen tension are significant predictors of ACS in SCD.
Background:
Acute chest syndrome is a major cause of pulmonary disease and mortality in sickle cell disease patients. Its diagnosis can be delayed due to differing imaging patterns between children and adults.
Objective:
The purpose of this study was to describe the pulmonary and extrapulmonary imaging findings in sickle cell disease patients with acute chest syndrome and determine differences in findings between adult and pediatric patients.
Patients And Methods:
This retrospective study analyzed the data of all sickle cell disease patients who were admitted with a diagnosis of acute chest syndrome to King Fahd Hospital of the University, Al Khobar, Saudi Arabia, between January and June 2015 (n = 150). After grouping the patients into adults and pediatrics, the pulmonary and extrapulmonary characteristics were identified and the digital radiography, computed tomography and laboratory findings were compared.
Results:
A total of 116 patients with 163 acute chest syndrome episodes met the inclusion criteria, of which 69 (60%) were adults. In both adult and pediatric patients, the most frequent pulmonary finding was consolidation of the lung parenchyma. The right lung was most frequently involved: the lower lobe in adult patients and the middle lobe in pediatric patients. In addition, pleural effusion was observed in both age groups. Extrapulmonary radiological findings, such as avascular necrosis and cardiomegaly, were significantly more common in adult patients than in pediatric patients (P < 0.05). Compared with adults, pediatric patients had significantly lower hemoglobin levels (P = 0.001) and oxygen tension fraction in arterial blood (P = 0.007).
Conclusions:
Pediatric and adult sickle cell disease patients with acute chest syndrome typically exhibited similar pulmonary characteristics, whereas extrapulmonary findings were more prominent in adult patients. Furthermore, low levels of hemoglobin and oxygen tension fraction were dependent predictors of acute chest syndrome.
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