What is the role of CT scanning in the workup of sickle cell disease (SCD)?

Updated: Jul 24, 2019
  • Author: Ivan Ramirez, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Answer

Although CT is not an initial study in most patients, CT scans can show findings of osteonecrosis, including sclerosis, collapse of bone (especially femoral heads), and a bone-within-bone appearance. CT may be useful to demonstrate subtle regions of osteonecrosis not apparent on plain radiographs in patients who are unable to have an MRI. [23]

Findings of osteomyelitis, including periosteal reaction, cortical or bone destruction, cloacae (sinus tracts), and sequestra or dead bone can be identified on CT scans (see the images below). Bone and soft tissue abscesses are demonstrated on contrast enhanced CT scans as low attenuation fluid collections with peripheral rim enhancement with or without internal gas. CT is not the test of choice for evaluation of acute osteomyelitis.

Skeletal sickle cell anemia. Osteomyelitis. CT sca Skeletal sickle cell anemia. Osteomyelitis. CT scan in a soft tissue window demonstrates a large abscess in the left thigh encircling the femur, with hypoattenuating pus surrounded by a rim of vivid enhancement.
Skeletal sickle cell anemia. Osteomyelitis and bon Skeletal sickle cell anemia. Osteomyelitis and bone-within-bone. Bone-window CT scan in the same patient as in the previous image shows a bone-within-bone appearance (concentric rings of cortical bone) in the right femur. On the left, a sinus tract (cloaca) traverses the lateral aspect of the femoral cortex, and a small, shardlike sequestrum is present deep to the sinus tract.

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