Case contributed by Mohammad Taghi Niknejad
Diagnosis certain


Chronic headache.

Patient Data

Age: 30 years
Gender: Male

Brain and paranasal sinuses


Diffuse calvarial thickening with widening of diploic space is present more prominent in the frontoparietal region. Thickening of facial bones is also noted.
Retention cysts are seen at sphenoid and right maxillary sinus. Mild mucosal thickening also is observed at some of the ethmoidal air cells (sinusitis).
S-shaped nasal septal deviation is observed.

Chest and abdomen


Diffuse reticular opacities are seen at both lung fields predominantly on basal segments.
Several enlarged mediastinal lymph nodes are seen with maximum diameter of 12 mm. There are also multiple paravertebral soft tissue masses with maximum diameters of 31 x 20 mm.
Diffuse osteoporosis with enlargement of ribs and sternum are seen.
Hepatomegaly is present with diffuse increased liver density. A 38 x 28 mm ill-defined hypo-attenuating mass is present at segment II of the liver.
The spleen is markedly enlarged and its craniocaudal height measured 253 mm.
A 50 x 43 mm thin-walled well-defined cyst is noted at the superior aspect of the spleen. A 60 x 29 mm well-defined mass is present between the posterior aspect of the spleen and right adrenal gland.
Diffuse osteoporosis with enlargement of the bony structures of the pelvis is seen.

Case Discussion

Known case of thalassemia with main findings as follow:

  1. calvarial thickening with widening of diploic space
  2. diffuse osteoporosis and enlargement of non-axial bony structures
  3. mediastinal enlarged lymph nodes
  4. thoracic paravertebral masses in favor of extramedullary hematopoiesis
  5. hepatomegaly and hyperattenuating liver consistent with hemochromatosis
  6. hepatic mass; needs for more evaluation
  7. huge splenomegaly and splenic cyst
  8. sinusitis

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