Presentation
Gross hematuria and bilateral flank pain for 2 days. Known sickle cell disease with regular blood transfusions.
Patient Data
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Coarse bony trabeculae in the radiographed skeleton and multiple H-shaped thoracic vertebrae, consistent with sickle cell disease. A few surgical clips of previous cholecystectomy are seen in the right hypochondrium. Heart and lungs are within normal limits.
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No radiopaque renal tract calculi, hydroureteronephrosis or perinephric fat stranding/collection is seen. Hyperdense foci (likely blood) in the lower pole calyx of the left kidney and urinary bladder. Mild fat stranding around the urinary bladder, ?cystitis. Enlarged hyperdense liver. Atrophic calcified spleen. S/P cholecystectomy. Heterogeneous bone density of the visualized skeleton and H-shaped lumbar and thoracic vertebrae.
Case Discussion
This case has classical abdominal and skeletal imaging features of an adult sickle cell disease patient:
- enlarged hyperdense liver, likely secondary hemochromatosis, due to serial blood transfusions
- atrophic calcified spleen (autosplenectomy)
- S/P cholecystectomy: higher rates of gallstones
- heterogeneous bone density of skeleton with H-shaped lumbar and thoracic vertebrae due to bone infarcts
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