Pooling of blood in the spleen is a frequent occurrence in children with si
ckle 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 enlarge
ment, circulatory collapse, and even death. The diagnosis is usually clinic
al, 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 th
e patient who presents to the emergency department with non-specific findin
gs of an acute abdomen, it is important to recognize the appearance of sequ
estration on imaging studies. We studied seven patients utilizing contrast-
enhanced Cr scans and found two distinct patterns - multiple, peripheral, n
onenhancing low-density areas or large, diffuse areas of low density in the
majority of the splenic tissue. Although radiological imaging is not alway
s necessary to diagnose splenic sequestration, in those situations where th
is diagnosis is not immediately obvious, it makes an important clarifying c
ontribution.