Extradural spinal lesions result in moderate to severe spinal canal stenosis, consistent with clinical history of thoracic radiculopathy. The classical paravertebral masses with the ancillary signs (splenomegaly, coarse trabeculated bony skeleton sclerosis) support the underlying chronic hemolytic anemia. The presence of extradural spinal lesions which have similar intensities to the paravertebral masses and the vertebral bone marrow suggest the diagnosis of extramedullary hematopoiesis. Spinal canal is not the usual typical common sites for extramedullary hematopoiesis.

This patient has thalassemia major disease which requiring regular blood transfusion. They went on to have 10 cycles of radiotherapy and more regular blood transfusions with improving thoracic radiculopathy.

Extramedullary hematopoiesis should be considered as one of the differential diagnosis for spinal epidural lesion in the correct patient groups (chronic hemolytic anemia) in order to avoid unnecessary and risky biopsy.

*Image courtesy of radiologist Dr Norhaslinda Bt Kamiso.