Extramedullary hematopoiesis

Case contributed by Assis Prof Faeze Salahshour

Presentation

History of anemia since the pediatric period, now presented with upper abdominal pain and dyspnea

Patient Data

Age: 30 years
Gender: Male

Contrast-enhanced thoracic CT shows multiple enhancing soft tissue masses in bilateral para-vertebral gutters in favor of extramedullary hematopoiesis.

Moderate pleural effusion and a chest tube with the passive collapse of the right lung base is evident in the right hemithorax. Amorphous dense material in the effusion in right hemithorax is in favor of hematoma.

Another soft tissue mass of extramedullary hematopoiesis is also seen in the pre-sacral area. Evidence of splenectomy and hepatomegaly is seen.

Few smaller than 2-centimeter hepatic nodules with delayed washout but without arterial hyper-enhancement are seen in the left liver lobe.

Annotated image

Red arrows point to pre-sacral and paravertebral extramedullary hematopoiesis. Blue arrow points to hepatic lesions.

Case Discussion

The patient has a history of beta-thalassemia intermedia with multiple transfusions and a history of the previous splenectomy. He referred because of dyspnea and abdominal pain. No specific cause for abdominal pain was found. The right-side pleural effusion drained by chest tube insertion.

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