CHEST X-RAY Patients with chest pain, suspected pneumonia, or dyspnea/respiratory symptoms should have chest radiographs. It is important to remember that in acute chest syndrome, the x-ray may appear normal for the first 48 h; thus a normal-appearing radiograph does not preclude significant pulmonary pathology.
EXTREMITY X-RAYS Extremity x-rays should be obtained in patients in whom ischemic necrosis of the femoral or humeral head is suspected or in those with localized bony tenderness. Avascular necrosis of the femoral head occurs in up to 12 percent of SCD patients. Small lytic lesions are also seen in patients with sickle dactylitis. Plain radiographs are somewhat limited in diagnosing bony infarction and/or osteomyelitis acutely. It may take 10 to 14 days for the radiographic changes to become evident. A bone scan or MRI can detect changes consistent with osteomyelitis usually within 24 h.
CT/MRI OF THE HEAD CT or MRI of the head should be obtained in SCD patients with any lateralizing neurologic signs or acute/new neurologic deficits.
ABDOMINAL ULTRASOUND OR CT These tests may be helpful in patients with abdominal pain, especially if a surgically correctable cause is suspected. The diagnosis of typical intraabdominal pathology (i.e., appendicitis, cholecystitis, pancreatitis, abscesses, bowel obstruction/infarction) with these imaging modalities is not affected by the presence of vasoocclusive crisis.
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