Computerized Tomography Findings in Abdomen and Chest of Patients with Sickle Cell Disease

Abstract

The study aimed to characterize the spleen in patients with SCD using computerized tomography scan in all enhancement phases. The spleen locations, shape, size, CT number and vascular findings were also been evaluated. As well full depiction of the associated lesions characteristics were studied at all types of SCD including hemoglobin SS, hemoglobin SC, hemoglobin SB+ (Beta) thalassemia and Beta-Zero thalassemia. And the complications occur in abdominal organs and chest were correlated according to patient’s age and SCD types. A total of 67 Saudi SCD patients were evaluated with CT in Ballasmar general hospital and King Fahad central hospital during the period spanned from 2014- 2017. The Study characterized the spleen in SCD patients ,it was found to be extended until the lower third of the left kidney when it is enlarged by percentage of 38%, and it can be oval, irregular, blurred out line with loss of its normal medial concavity. The features of spleen size was variants to be enlarged or shrunken present in 31 and 24 cases respectively. This changes in spleen size was significantly correlated with the reduction of HU CT number of the spleen at p≤0.004. Study also found that there was a significant relation between the spleenic vein dilatation and splenomegaly and those of enlarged lymph nodes at p≤0.00 and p≤0.00. CT scan contrast enhancement showed well characteristics of spleen lesions occurred as complications from SCD (cysts, abscess and infarctions) and well differentiation between them depending on the timing of intravenous bolus administration of contrast material. Spleen abscess in all of the enhancement phase in patients affected with sickle cell disease is well defined in both venus and delay phase in 15 and 19 cases respectively, and 58.3% are peripherally II enhanced with hypodensity in the center of lesion, where most of the abscess are ill defined in the arterial phase. Cysts are well enhanced in the arterial phase which occurred in 7 patients, and most of them characterized by full regular circle enhancement by percentage of 62.5%, while spleen infarction showed well defined wedge-shaped based area of hypo attenuation which was mostly peripheral without pressure effect on adjacent structures in the delay phase which present in 66.6% of cases. On non-enhanced CT and arterial enhancement, infarcts are poorly visualized. The study also showed a significant relation between the character of the lesions and degree of enhancement with the scanning technique used (pre contrast, venous and delay phase) in different SCD types at p≤ 0.05. The common SCD type was found to be hemoglobin SS where there are significant relation between the type of the SCD and the character of the lesion in the venous and delay phase at p≤0.037 and 0.055 in respectively. Study found that the hepatic complications were, hepatic focal necrosis, hepatomegaly, hepatic abscess, cyst and infarctions occurred in 8,19,12,10 and 10 patients respectively, while pancreatic and biliary complications were acute pancreatitis and cholelithiasis present in 5 and 22 patients respectively. The renal changes include renal papillary necrosis, renal abscess, stones with hydronephrosis, renal vein thrombosis, renal failure and renal infarction found in 15,7,11,4,7 and 11 patients respectively, as well the lung complications was pleural effusion, pneumonia, atelectasis, ground glass nodules, consolidation, fibrosis and lung abscess occurred in 16,6,4,5,8,10 and 7 patients respectively. Study considering patients age and SCD types in all those previous abdominal organs and chest complications. The study concluded that, the findings of SCD complications can identified by using MDCT at different CT scan phases.