The spleen is one of the most frequently affected organs in sickle cell anemia (SCA). This study aims to characterize the spleen in sickle cell anemia patients using contrast enhanced computerized tomography scanning (CECT). 67 patients with SCA from different Saudi Arabian areas were enrolled; ages are ranged from 10 months to 28 years old. The spleen was assessed with CT for abdominal pain and/or unexplained fever. The evaluation was done at different contrast enhancement scanning phases. The study showed that the least number of affected patients was from Eastern Saudi Arabia (1.5%) followed by Asseer (16.4%) then Gazan representing 82.1%. The most common type of SCA affected the Saudi children is Hemoglobin SS Disease (Hb SS) constituting 41 (61.2%). The spleen size, lymph nodes size, spleen Hounsfield (HU), splenic vein diameter and the correlation with the associated findings were evaluated for all of the patients. In children affected with SCA: 26 (38.8%) have splenomegaly, 18 (26.9%) have atrophied spleen and 2 (3.0%) are with very small tissue like structure. Lesions found in the spleen were abscess, infarction, cyst, and calcifications. At the spleen hilum region; dilated splenic vein, presence of multiple collaterals, and thrombus were also been detected. Significantly correlations were noticed between lesions type, child age, enlargement of spleen and splenic lymph nodes at P ≤ 0.033, P ≤ 0.010 and P ≤ 0.012 respectively and showed an evidence that the reduction of the HU and advanced age have significant relation with changing of the spleen size at P ≤ 0.004 and P ≤ 0.000 respectively. Spleen lesions' enhancement pattern is well emerged in both venous and delay phase and it was significantly related with the scanning phase at P ≤ 0.000 and with different types of SCA at P ≤ 0.037, and P ≤ 0.055 in venous and delay phase in respectively. CECT offers a number of morphological criteria that can be applied to differentiate hypodense lesions of the spleen in SCA. CT characterization criteria of hypodense splenic lesions are acknowledged to aid interpretation during evaluation of abdominal CT images of the spleen in symptomatic patients with sickle cell anemia.

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