Presentation
Attended with chest pain following an RTA. No prior medical history indicated.
Patient Data
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CXR: Bilateral paraspinal masses - symmetrical in nature at the level of the heart. Abnormal contour at the right hilar level, but the hilum is separately delineated (hilum overlay sign).
AXR: Splenomegaly down to the level of the iliac crest. Coarse trabeculation of the bony skeleton.
Minor expansion of some of the ribs, most pronounced in the upper thoracic cavity, with narrowing of the intercostal spaces.
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Multiple smooth paraspinal masses. Hepatosplenomegaly (in particular severe splenomegaly). Increased density and trabeculation of the bony skeleton.
Case Discussion
Classical appearances of extramedullary hematopoiesis, in this case from thalassemia. The paraspinal regions are a very common site.
The plain films are both abnormal - in particular a good example of the hilum overlay sign and also how one approaches the film to delineate the location of a mass in the mediastinum (anterior, middle, posterior).
The plain radiographs and CT together and the correlation of signs for the definitive diagnosis is the stuff of FRCR 2B and other fellowship examiners dreams.
Hey presto, don't you just love radiology!