Acute chest syndrome

(Redirected from Acute Chest Syndrome)


  • The leading cause of death in patients with HbSS in the United States
  • Occurs most commonly in the 2-4yr old age group and then declines with age
  • Due to pulmonary ischemia and infarction; complication of pneumonia


Clinical Features


Differential Diagnosis

Sickle cell crisis


Chest X-ray of TRALI (left) compared to the same subject after resolution of symptoms (right).



  • New infiltrate seen on chest x-ray
    • Chest x-ray findings may lag behind clinical features
  • Lung ultrasound to CXR or CT finding correlations[1]
    • Consolidation seen as hyperechoic punctiform air bronchograms
    • Ground-glass opacities seen as coalescent B lines
    • Pleural effusion, defined as large if interpleural distance > 25 mm


  • O2
    • Titrate to pulse oximetry >95%
  • Hydration
    • Oral hydration preferred
    • IV hydration with hypotonic fluid if patient unable to tolerate PO
      • Consider D5 + 1/2 Normal saline at 1-1.5x maintenance rate
  • Analgesia
    • Prevent oversedation and hypoventilation
  • Incentive Spirometry
  • Bronchodilators
  • Antibiotics
  • Transfusion (leucocyte depleted)
    • Consider transfusion to goal of hemoglobin 11 / hematocrit 30 for:
      • O2 Sat <92% on room air
      • hematocrit 10-20% below patient's usual hematocrit or dropping hematocrit
  • Exchange transfusion
    • Consider for:
      • Progression of acute chest syndrome despite simple transfusion
      • Severe hypoxemia
      • Multi-lobar disease
      • Previous history of severe acute chest syndrome or cardiopulmonary disease
    • Can prevent the need for intubation

See Also

External Links




  1. Razazi et al. Bedside Lung Ultrasound During Acute Chest Syndrome in Sickle Cell Disease. Medicine (Baltimore). 2016 Feb; 95(7): e2553.