The diagnosis is made primarily by history and physical examination and is characterized by the acute onset of severe left-upper quadrant pain and tenderness along with muscle rigidity. The spleen is usually enlarged and very tender with splinting, left pleural effusion and atelectasis of the left lung. Laboratory findings vary with the degree of sequestration with mild or transient anemia. The etiology is felt to be altitude induced hypoxia typically in unpressurized airplanes but has occurred at mountain altitudes of 5,000 to 7,000 ft above sea level. 12-13 Infarction during high altitude exposure on land usually occurs after heavy physical exertion, which promotes sickling by metabolic effects such as acidosis, hypoxia and dehydration.
Most cases tend to be self-limiting with supportive medical management only.
Surgical intervention has seldom been required. Exertional Heat Illnesses There has been considerable controversy over the years as to whether sickle cell trait is associated with unexpected death during exercise. The initial reports were centered around the deaths of 39 new military recruits in basic training between 1977 and 1981. In a retrospective and comprehensive review of these deaths, Kark and coworkers 15 demonstrated that the risk of sudden, unexplained death in black recruits with sickle cell trait was approximately 30 times that of black recruits without the trait, and 40 times that of nonblack recruits. Their analysis revealed that the specific types of death statistically associated with sickle cell trait were exertional rhabdomyolysis, exertional heat illness, and exercise related sudden unexplained cardiac arrhythmia.