DISCUSSION: Acute shortness of breath in patients with SCD can be due to acute chest syndrome (ACS), pneumonia, pulmonary embolism or pulmonary hypertension, among others. ACS can present with fever, cough, dyspnea, consolidation and pleural effusion2 - all of which were present in this patient. Mediastinal lymphadenopathy may occur secondary to infection including histoplasmosis in endemic areas and HIV; extramedullary hematopoiesis; malignancy; and granulomatous disease like tuberculosis and sarcoidosis (especially in African-Americans). Lymphadenopathy may also simply be reactive. The most common cause for a tumoral mass in SCD is extramedullary hematopoiesis.1 Pathological or microbiological confirmation is recommended in patients with mediastinal lymphadenopathy. There are some reports of patients with sickle cell disease or trait developing hematologic dyscrasias like myelodysplasia and acute myeloid leukemia, but no clear causal link has been defined either with the disease or hydroxyurea therapy.3 Only rare, usually single, case reports exist for co-existent hematologic neoplasias in patients with SCD.1 Mediastinal tumors in T-ALL are usually responsive to chemotherapy.