15 year old boy with no clinical history

 

Doctor's Information

Name : Morteza
Family :Sanei Taheri
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Hussein Soleiman Tabar

 

Patient's Information

Gender : Male
Age : 15

 

Case Section

Muskuloskeletal System

 

Clinical Summary

15 year old boy with no clinical history

 

Images

 

Imaging Procedures and Findings

This is a known case of B-thalassemia. There is diffuse decrease in marrow signal ( as a result of red marrow conversion). Also liver and spleen show enlargement and decreased signal intensity of liver that could be due to iron overloading..

 

Discussion

Skeletal changes in thalassaemia arise from the chronic anaemia associated with the condition.In the skull, there is widening of the diploic spaces (low signal on all MRI sequences) with thinning of the outer table of the skull vault. The trabecular markings are oriented perpendicular to the inner and outer tables and on plain radiographs this gives rise to the ??hair-on-endâ?? appearance. There is frontal bossing and overgrowth of the facial bones with reduced pneumatization of the paranasal sinuses. The so-called ??rodent faciesâ?? arises from marrow hyperplasia in the maxillae causing lateral displacement of the orbits and ventral displacement of the central incisors.In the spine there may be marked osteoporosis and cortical thinning resulting in fractures of the vertebral bodies and platyspondyly. Imaging may reveal paraspinal masses (as a result of extramedullary haematopoiesis). Cord compression can result if these masses extend into the extradural space. MRI findings are secondary to blood transfusion and chelation therapy.There may be expansion of the head and neck of the ribs and osteoporosis. A rib within a rib appearance may result. Extramedullary haematopoiesis can cause erosions of the inner cortex of the ribs or manifest as a posterior mediastinal soft tissue mass. Premature fusion of the growth plates (particularly of the proximal humerus and distal femur) is a recognized feature. Irregular sclerosis at the metaphyses and anterior rib ends is a recognized complication of treatment with desferrioxamine

 

Final Diagnosis

Thalassemia

 

References

Adam: Grainger & Allison's Diagnostic Radiology, 5th ed.

 

end faqaq

 

Go to top