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Hair on end sign

Case contributed by Iqbal Naseem
Diagnosis certain

Presentation

A young girl with known history of repeated blood transfusions presented with severe anemia.

Patient Data

Age: 11 years
Gender: Female
x-ray

Radiograph skull AP and Lateral views showing widened diploic space and vertical striations running perpendicularly in diploic space giving rise to characteristic hair on end appearance.

Case Discussion

Skeletal findings in chronic hemolytic disorders are manifestations of extra-medullary hematopoiesis.

Extra-medullary hematopoiesis manifests in spine as paravertebral masses.

In skull it manifests as widened diploic space and vertical striations running in diploic space giving rise to characteristic hair on end sign.

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