What are the physical examination findings for acute chest syndrome in sickle cell disease (SCD)?

From the Guidelines

Physical examination for acute chest syndrome in sickle cell disease should focus on respiratory status, vital signs, and evidence of systemic involvement, including assessing respiratory rate, oxygen saturation, and work of breathing, as well as looking for signs of respiratory distress and systemic involvement. When evaluating a patient with suspected acute chest syndrome, it is crucial to begin by assessing respiratory rate, oxygen saturation, and work of breathing, as these can indicate the severity of the condition 1. Key findings may include signs of respiratory distress such as tachypnea, nasal flaring, intercostal retractions, and use of accessory muscles.

Key Examination Findings

• Assess respiratory rate and oxygen saturation to evaluate the need for oxygen therapy
• Look for signs of respiratory distress, including tachypnea, nasal flaring, and intercostal retractions
• Auscultate the lungs for decreased breath sounds, crackles, wheezing, or rubs that may indicate consolidation, effusion, or atelectasis
• Check vital signs for fever, tachycardia, and hypotension which may suggest infection or severe disease
• Examine for chest pain, which is typically pleuritic in nature, and assess for signs of hypoxemia including cyanosis, altered mental status, or lethargy
• Evaluate for jaundice, pallor, or other signs of worsening anemia
• Perform a thorough abdominal examination to evaluate for hepatomegaly or splenic sequestration, as these can be associated with acute chest syndrome in sickle cell disease 1.

Importance of Serial Examinations

Serial examinations are essential as acute chest syndrome can rapidly progress to respiratory failure, and early recognition and aggressive treatment with oxygen, incentive spirometry, analgesics, antibiotics, and often, simple or exchange transfusions, may be necessary to prevent morbidity and mortality 1.

From the Research

Physical Examination Findings for Acute Chest Syndrome in SCD

The physical examination findings for acute chest syndrome (ACS) in sickle cell disease (SCD) include:

• Hypoxia 2, 3, 4
• Decreasing hemoglobin values 2
• Progressive multilobar pneumonia 2
• Fever 2, 3, 4
• Respiratory symptoms 2, 3, 4
• New pulmonary infiltrate on chest X-ray 3, 4

Clinical Presentation

The clinical presentation of ACS in SCD can vary, but common features include:

• Painful crisis 2, 4
• Respiratory failure 2, 3, 4
• Neurologic events 2
• Pulmonary fat embolism 2, 3
• Infection, especially community-acquired pneumonia 2, 3

Diagnostic Findings

Diagnostic findings for ACS in SCD include:

• Chest X-ray showing new pulmonary infiltrate 3, 4
• Blood and respiratory tract secretions sent to central laboratories for antibody testing, culture, DNA testing, and histopathological analyses 2