Chest computed tomographic findings in patients with sickle cell disease–related acute chest syndrome: A retrospective study

Background: Sickle cell disease (SCD) is a hematological condition with significant pulmonary involvement, especially in episodes of acute chest syndrome (ACS). Defining radiographic pulmonary features during an ACS episode can expand our understanding of this complication. Aim: We aimed to describe the radiological pulmonary features of SCD patients with ACS to better understand this condition from a radiographic perspective. Method: This retrospective study was conducted on adult patients with ACS admitted to King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia during the period from January 2016 to June 2020. Data collection included clinical and demographic information and radiological descriptions of inflammatory and fibrotic features from computed tomography (CT) of the chest. Results: We reviewed chest CTs for 44 patients, including 30 males (68.2%) and 14 females (31.8%). Hemoglobin SS (HbSS) was the dominant HB genotype in 34 patients (77.3%). The most frequent findings on the chest CTs were consolidation, mainly in the lower zones, which was noted in 32 patients (72.7%), and cardiomegaly in 23 patients (52.3%). Fibrosis was noted in 14 patients (31.8%), assessed by the presence of parenchymal scarring, subpleural reticulation, architectural distortion, traction bronchiectasis, or volume loss. The distribution of abnormalities was predominantly in the lower lung zones. Conclusion: Inflammatory changes in lung parenchyma were common in ACS, mainly in the lower lung zones. In the SCD patients, cardiomegaly was a common cardiac radiographic abnormality. Pulmonary fibrosis was noted in one-third of the patients, dominated by scattered parenchymal scarring that lacked a specific fibrotic pattern.