Prague Med. Rep. 2013, 114, 180-185

Painful Vaso-occlusive Crisis as a  Prodromal Phase of Acute Chest Syndrome. Is Only One Chest X-ray Enough? A Case Report

Charalambos Neocleous1,2,*, C. Spanou3,  A. Adramerina1, G. Spyrou1, F. Tzanetis1

1Department of Pediatrics, General Hospital of Drama, Drama, Greece
2Medical School, University of  Thessaly, Larisa, Greece
3School of Physical Education and Sports Science in  Serres,  Aristotle University of Thessaloniki, Serres, Greece

The predominant pathophysiological feature of homozygous sickle cell anemia (SCA) is the vaso-occlusion. Vaso-occlusion can be associated with painful crises, which are the primary reason for those patients to seek medical care. Vaso-occlusion is responsible for the acute chest syndrome (ACS) with large morbidity and mortality or more rarely (and especially in adults) for priapism and acute neurological events (strokes). A 10-year-old boy with homozygous SCA was admitted to the Pediatric Emergencies with painful vaso-occlusive crisis and fever. Initially he had normal chest X-ray but, after 24-hour-hospitalization, he developed  ACS with new chest X-ray findings. He was treated with broad spectrum antibiotics, blood transfusions and bronchodilators and after a  six-day treatment, he was significantly improved. The patient was discharged 13 days later with no other therapy at home. The possibility of  ACS development should be still considered, even when a  known patient with SCA presents a  painful vaso-occlusive crisis with an initial normal chest X-ray. Therefore, repeated clinical examination is required and possible changes in  the clinical status could indicate the necessity of a  new radiographic examination. In  this way, early  ACS could be recognized and the catastrophic consequences due to this syndrome could be avoided.


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