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Esterson YB, Sheth S, Kawamoto S. Splenic sequestration in the adult: cross sectional imaging appearance of an uncommon diagnosis. Clin Imaging 2020; 69:369-373. [PMID: 33070084 DOI: 10.1016/j.clinimag.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/23/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
Acute splenic sequestration crisis, the sudden pooling of red blood cells in the spleen, is an emergent process typically seen in children with homozygous sickle cell disease. Splenic sequestration has rarely been reported in adults with heterozygous sickle cell conditions, including sickle cell beta(+)-thalassemia disease (HbS/β+-thalassemia). Here we present a case of a 32-year-old man with HbS/β+-thalassemia who suffered an acute splenic sequestration crisis. We review the CT and ultrasound appearance of splenic sequestration, which include splenic enlargement and an irregular rim of hypoenhancing or hypoechoic tissue at the periphery of the spleen, and discuss imaging differential considerations. To our knowledge, this is only the nineteenth case of acute splenic sequestration to be reported in an adult with HbS/β+-thalassemia in the English literature, and only the second case in which ultrasound findings are reported.
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Affiliation(s)
- Yonah B Esterson
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA.
| | - Sheila Sheth
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA
| | - Satomi Kawamoto
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA
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Malinowski AK, Parrish J, D'Souza R, Kuo KH, Ward R, Shehata N. Adverse outcome of acute splenic sequestration crisis in pregnancy. Obstet Med 2020; 14:113-115. [PMID: 34394722 DOI: 10.1177/1753495x20936902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background Acute splenic sequestration crisis, characterized by abrupt fall in hemoglobin, splenomegaly, hypovolemia, and often thrombocytopenia, occurs infrequently in adults with sickle cell disease and extremely rarely during pregnancy. Case A 25-year-old woman with HbSC presented at 33 weeks' gestation with vaso-occlusive pain. Sudden worsening of abdominal pain and non-reassuring fetal surveillance on day 3 of admission led to emergent delivery. Acute splenic sequestration crisis was the diagnosis of exclusion based on clinical presentation and intra-operative hemoglobin of 37 g/L. Five- and 10-minute Apgar scores were 4. Neonatal brain magnetic resonance imaging revealed significant diffuse white matter abnormalities. Conclusion Acute splenic sequestration crisis in pregnancy must be considered in the differential diagnosis for this patient population as it can evolve rapidly and lead to maternal and fetal compromise.
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Affiliation(s)
- Ann Kinga Malinowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Jacqueline Parrish
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - Rohan D'Souza
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Kevin Hm Kuo
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Haematology, Department of Medicine, University Health Network, Toronto, Canada
| | - Richard Ward
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Haematology, Department of Medicine, University Health Network, Toronto, Canada
| | - Nadine Shehata
- Department of Medicine, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Division of Haematology, Department of Medicine, Mount Sinai Hospital, Toronto, Canada.,Division of Medical Oncology and Haematology, Department of Medicine, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, Canada
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Maia CB, Nomura RMY, Igai AMK, Fonseca GH, Gualandro SM, Zugaib M. Acute splenic sequestration in a pregnant woman with homozygous sickle-cell anemia. SAO PAULO MED J 2013; 131:123-6. [PMID: 23657515 PMCID: PMC10871732 DOI: 10.1590/s1516-31802013000100023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 08/11/2011] [Accepted: 09/04/2012] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Homozygous (SS) sickle-cell anemia complicated by acute splenic sequestration in adults is a rare event, and it has never been reported during pregnancy. CASE REPORT A 25-year-old woman with homozygous (SS) sickle-cell disease was hospitalized at 32 weeks' of gestation presenting weakness, abdominal pain, fever and hemoglobin of 2.4 g/dl. Abnormal fetal heart rate was detected by means of cardiotocography, and 5 units of packed red cells were transfused. Cesarean was performed at 37 weeks. Both mother and baby were discharged in a good general condition. CONCLUSION This case report demonstrates the importance of immediate blood transfusion for treatment of fetal distress in cases of splenic sequestration during pregnancy. This treatment is essential for avoiding maternal and fetal complications.
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Affiliation(s)
- Carolina Bastos Maia
- Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil.
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