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.