A 29Y/O man with back pain

 

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Doctor's Information

Name : Morteza
Family :Sanei Taheri
Affiliation : ----------------
Academic Degree: Radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Samira Shahhamzei

 

Patient's Information

Gender : Male
Age : 29

 

Case Section

Muskuloskeletal System

 

Clinical Summary

A 29Y/O man complains from acute back pain

 

 

Imaging Procedures and Findings

Sagittal T2WI and Post GAD T1WI reveal acute collapse in lower thoracic vertebrae associated with edema.(old compression Fx is also noted). Collapse Fx is seen in superior border of two higher vertebrae,too. Decreased marrow signal in all vertebral bodies is noted. Axial T1WI (pre and post contrast ) shows paravertebral masses which are enhanced after contrast. Areas of high signal intensity is noted in the mass. This patient has hx of thalassemia. All MRI findings are correlated with patient hx .

 

Discussion

Extramedullary hematopoiesis is a compensatory phenomenon that occurs when erythrocyte production is diminished or destruction is accelerated. Extramedullary hematopoiesis is usually seen in patients with chronic hemolytic disorders such as thalassemia, hereditary spherocytosis, sickle cell disease, or extensive bone marrow replacement owing to myelofibrosis. Extramedullary hematopoiesis is usually microscopic and commonly involves the liver, spleen, and lymph nodes. Thoracic manifestations are less common and consist of paravertebral soft tissue masses. The masses represent extrusion of the marrow through the thinned cortex of the posterior ribs. The masses are usually bilateral, contain no calcification, and cause no rib destruction. On CT, extramedullary hematopoiesis manifests as a heterogeneous mass or masses, often with focal areas of fat within the lesion . Tl- and T2-weighted MR images typically show bilateral heterogeneous masses with increased signal intensity on Tl-weighted images because of fat within the masses .

 

Final Diagnosis

Extra medullary hematopoiesis in thalassemia

 

References

Haaga John.R. CT and MRI of the Whole Body, 5th edition. P1008

 

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