SHM Converge Scientific Abstract ePoster Gallery-Rib Infarction: An Overlooked Cause of Sickle Cell Chest Pain

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This case describes a 57-year-old man with sickle cell disease and a history of acute chest syndrome, hyperhemolysis, and pulmonary fibrosis who was hospitalized for a vaso-occlusive crisis triggered by rhinovirus infection and severe hemolytic anemia (hemoglobin 3.8 g/dL). He initially needed high-flow nasal cannula but improved after transfusion with premedication.<br /><br />After stabilization, he developed persistent, localized left anterior chest pain that was different from his usual sickle cell pain. Because of concern for serious cardiopulmonary causes, pulmonary embolism was ruled out and troponins and EKGs were normal. On re-review of chest CT imaging, a chest wall bony infarct involving the rib was identified, explaining his pain.<br /><br />The case highlights that chest pain in sickle cell disease is not always due to acute chest syndrome, pulmonary embolism, or cardiac disease. Rib and chest wall infarctions are under-recognized causes that can be missed on initial imaging, as findings may be subtle or absent early on. MRI is often more sensitive than CT for detecting osseous infarction.<br /><br />The patient’s symptoms improved with supportive care and analgesia once the diagnosis was recognized and his pain was validated.<br /><br />Overall, the report emphasizes the importance of considering chest wall infarction in the differential diagnosis of focal chest pain in sickle cell disease and of collaborating closely with radiology to identify subtle bony infarcts early.

Asset Subtitle

Robert W. Trenschel

Meta Tag

Author List Patricia Dharapak, Robert W. Trenschel

Category Clinical Vignettes

Concept Chest Wall Infarction

Concept Sickle Cell Disease

Concept Focal Chest Pain

Concept Acute Chest Syndrome

Concept Imaging

Distinguished Non-Finalist

Presenter Organization Mount Sinai Morningside West

Presenting Author Robert W. Trenschel

Track Adult

Keywords

sickle cell disease

vaso-occlusive crisis

rhinovirus infection

hemolytic anemia

acute chest syndrome

chest wall infarction

rib infarct

focal chest pain

MRI sensitivity

pulmonary embolism

Chest Wall Infarction

Sickle Cell Disease

Focal Chest Pain

Acute Chest Syndrome

Imaging