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Extramedullary hematopoiesis

Case contributed by Dr Ian Bickle


Regular hospital attender. Peripheral clinic reported paravertebral mass on chest x-ray.

Patient Data

Age: 20 years
Gender: Male

Chest x-ray performed elsewhere not available - scanogram from CT in lieu of CXR.

Bilateral paravertebral mass.

Dense skeleton.


Large paravertebral soft tissue masses (not lymph nodes). Appearance of 'ping-pong' balls.

Coarse sclerosis of the bony skeleton (secondary changes of thalassemia).

Splenectomy (removed due to repeated infarcts).

High attenuation liver - due to multiple blood transfusions.

Annotated image

Black arrow: paravertebral masses. 

Red arrows:  extramedullary hematopoiesis.

Green arrow: splenectomy.

Blue arrows: bony sclerosis.

Case Discussion

Classical appearances of extra-medullary hematopoiesis with the ancillary signs supporting a patient with sickle cell anemia, one the of main patient groups who present with this condition.

  • large paravertebral soft tissue masses (not lymph nodes)
  • coarse sclerosis of the bony skeleton (secondary changes of thalassemia)
  • splenectomy (removed due to repeated infarcts)
  • high attenuation liver - due to multiple blood transfusions

It makes for a fantastic FRCR 2B long case or viva case for discussion.

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Case information

rID: 36625
Published: 6th May 2015
Last edited: 15th Feb 2020
Inclusion in quiz mode: Included

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