ED point-of-care ultrasound evaluation of acute splenic sequestration in sickle cell disease

Acute splenic sequestration is a life-threatening complication of sickle cell disease. While traditionally considered a clinical diagnosis not requiring imaging, the increasing availability of point-of-care ultrasound (PoCUS) in the emergency department (ED) presents an opportunity to re-evaluate its role in expediting diagnosis and management. This case series reports the use of PoCUS in the ED evaluation of pediatric patients with sickle cell disease presenting with suspected acute splenic sequestration. We describe key sonographic findings, including splenomegaly and altered splenic echogenicity. We present two cases of acute splenic sequestration where PoCUS rapidly identified splenomegaly and increased splenic echogenicity relative to the adjacent left kidney. In one case, these sonographic findings, prompted by left upper quadrant abdominal pain, preceded the characteristic drop in hemoglobin. Serial ultrasound measurements demonstrated a progressive increase in spleen size, correlating with the clinical course. In contrast, an asymptomatic control patient with a remote history of sequestration had normal spleen size and isoechoic parenchyma. These findings suggest that PoCUS may provide objective, real-time data that may be more reliable than physical examination for splenomegaly and can track the progression of sequestration. PoCUS may be a simple, rapid, and feasible tool for evaluating suspected acute splenic sequestration in the ED. Measuring spleen size and assessing for increased splenic echogenicity can aid in early diagnosis and inform timely management, potentially improving outcomes for patients with sickle cell disease.