Sickle cell disease

Case contributed by Andrew Ho
Diagnosis almost certain


Pre-operative chest x-ray

Patient Data

Age: 36
Gender: Female

Frontal and lateral chest radiographs reveals mildly enlarged cardiac silhouette, H-shaped vertebrae, bilateral patchy humeral head sclerosis, absent splenic shadow, calcified gallstones in the RUQ abdomen, and an enlarged hepatic silhouette.  No acute pulmonary pathology evident.

Case Discussion

Frontal and lateral chest radiographs demonstrates multiple bone and soft tissue findings associated with sickle cell disease:

  • H-shaped vertebrae with central end plate depression involving the superior and inferior endplates
  • Bilateral patchy humeral head sclerosis consistent with epiphyseal infarction
  • Absent splenic shadow with loops of bowel replacing the left upper quadrant abdomen suggesting autosplenectomy.  Later confirmed on CT (not shown)
  • Calcified gallstones seen in the right upper quadrant abdomen from radio-opaque bilirubin/pigmented gallstones
  • Enlarged heart secondary to chronic anemia
  • Enlarged liver shadow (not completely imaged) in keeping with hepatomegaly

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