CT imaging of splenic sequestration in sickle cell disease

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.