title: Expected Sonographic Appearance of the Spleen in Children and Young Adults With Sickle Cell Disease: An Update.
abstract: OBJECTIVE
  To update the imaging literature regarding spleen appearances in young patients with sickle cell disease (SCD).
  
  
  METHODS
  We conducted a retrospective study and included 112 patients age 0 to 21 years with SCD who had at least 1 abdominal sonogram at our institution between 1999 and 2011. Radiologic findings were compared between risk groups by χ(2) analysis. Findings were correlated with other imaging modalities when available.
  
  
  RESULTS
  In our cohort, 35.7% of patients had autosplenectomy, and 8.0% had undergone surgical splenectomy. Only 5.0% of individuals age 0 to 5 years had autosplenectomy. In those who had not undergone surgical splenectomy or autosplenectomy, 76.2% had echogenic spleens, heterogeneous-appearing spleens, or both, and patients with the homozygous sickle cell anemia (HbSS) genotype were more likely to have an abnormal spleen echo texture. Patients treated with transfusions had echogenic spleens and had a higher frequency of splenic regeneration nodules. Most patients (80%) with splenomegaly did not require surgical splenectomy after 5.7 years of follow-up.
  
  
  CONCLUSIONS
  Twenty years ago, children with HbSS SCD were expected to have autosplenectomy by age 5 years. There have been changes in the radiologic appearance of the spleen in patients with SDC, likely due to improved supportive care and the use of acute and chronic transfusion therapy. We found that autosplenectomy is rare by age 5 years, and during childhood and adolescence, the spleen typically appears echogenic, heterogeneous, or both, depending on disease severity.
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts USA.
authors.forename: Heather I
authors.initials: HI
authors.lastname: Gale
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Bobbitt
authors.affiliation: Boston University/Boston Medical Center, Boston, Massachusetts USA.
authors.forename: Bindu N
authors.initials: BN
authors.lastname: Setty
authors.affiliation: Hasbro Children's Hospital, Providence Rhode Island USA.
authors.forename: Philippa G
authors.initials: PG
authors.lastname: Sprinz
authors.affiliation: Boston University School of Public Health, Boston, Massachusetts USA.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: University of Utah, Salt Lake City, Utah USA.
authors.forename: Don D
authors.initials: DD
authors.lastname: Williams
authors.affiliation: Beth Israel Deaconess Medical Center, Brookline, Massachusetts USA.
authors.forename: Trevor C
authors.initials: TC
authors.lastname: Morrison
authors.affiliation: Department of Medical Clinical Sciences/ Graduate Medical Studies, Boston University School of Medicine, Boston, Massachusetts USA.
authors.forename: Tyler A
authors.initials: TA
authors.lastname: Kalajian
authors.affiliation: Stanford University, Stanford California USA.
authors.forename: Powen
authors.initials: P
authors.lastname: Tu
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts USA.
authors.forename: Shankar N
authors.initials: SN
authors.lastname: Mundluru
authors.affiliation: Boston University/Boston Medical Center, Boston, Massachusetts USA.
authors.forename: Ilse
authors.initials: I
authors.lastname: Castro-Aragon
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013156:Splenectomy; D013163:Splenomegaly / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: pediatric ultrasound; pediatrics; sickle cell disease; sonography; spleen