Lung imaging during acute chest syndrome in sickle cell disease: computed tomography patterns and diagnostic accuracy of bedside chest radiograph.
BACKGROUND
The lung computed tomography (CT) features of acute chest syndrome (ACS) in sickle cell disease patients is not well described, and the diagnostic performance of bedside chest radiograph (CR) has not been tested. Our objectives were to describe CT features of ACS and evaluate the reproducibility and diagnostic performance of bedside CR.


METHODS
We screened 127 consecutive patients during 166 ACS episodes and 145 CT scans (in 118 consecutive patients) were included in the study.


RESULTS
Among the 145 CT scans, 139 (96%) exhibited a new pulmonary opacity and 84 (58%) exhibited at least one complete lung segment consolidation. Consolidations were predominant as compared with ground-glass opacities and atelectasis. Lung parenchyma was increasingly consolidated from apex to base; the right and left inferior lobes were almost always involved in patients with a new complete lung segment consolidation on CT scan (98% and 95% of cases, respectively). Patients with a new complete lung segment consolidation on CT scan had a more severe presentation and course as compared with others. The sensitivity of bedside CR for the diagnosis of ACS using CT as a reference was good (>85%), whereas the specificity was weak (<60%).


CONCLUSIONS
ACS more frequently presented on CT as a consolidation pattern, predominating in lung bases. The reproducibility and diagnostic capacity of bedside CR were far from perfect. These findings may help improve the bedside imaging diagnosis of ACS.
Service de Réanimation Médicale, AP-HP, Groupe Henri-Mondor Albert-Chenevier, , Créteil, France.
Armand
A
Mekontso Dessap
Jean-François
JF
Deux
Anoosha
A
Habibi
Nour
N
Abidi
Bertrand
B
Godeau
Serge
S
Adnot
Christian
C
Brun-Buisson
Alain
A
Rahmouni
Frederic
F
Galacteros
Bernard
B
Maitre
D056586:Acute Chest Syndrome / Q000000981:diagnostic imaging*; D000328:Adult; D000755:Anemia, Sickle Cell / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D019095:Point-of-Care Systems; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
ARDS; Imaging/CT MRI etc; Rare lung diseases