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Weekly Chest CasesArchive of Old Cases

Case No : 1011 Date 2017-03-13

  • Courtesy of Jung-Gi Im / Maryam Hasan Darwish / Sheikh Khalifa Specialty Hospital, UAE
  • Age/Sex 35 / M
  • Chief ComplaintChronic fatigue
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Thalassemia (beta thalassemia major)
Radiologic Findings
Chest radiograph shows marked ballooning of ribs with 'rib-within-a-rib' appearance. CT shows diffuse osteopenia with ballooning, cortical thinning, and erosion of the ribs. Soft tissue inside the ribs and paravertebral region indicate extramedullary hematopoiesis.
High-attenuation of liver (95HU), myocardium (56 HU), abdominal lymph nodes (190 HU) are the findings of hemochromatosis caused by prolonged RBC destruction. Splenectomy and polycystic kidney are additional findings.
Brief Review
Thalassemia, which is most prevalent in Mediterranean region, is a kind of chronic, inherited, microcytic anemia characterized by defective hemoglobin synthesis and ineffective erythropoiesis. In all thalassemias, clinical features that result from anemia, transfusional, and absorptive iron overload are similar but vary in severity. The radiographic features of beta thalassemia are largely due to marrow hyperplasia. Markedly expanded marrow space lead to various skeletal manifestations involving the spine, skull, facial bones, and ribs. Extramedullary hematopoiesis, hemosiderosis, and cholelithiasis are among the non-skeletal manifestations of thalassemia. The skeletal X-ray findings show characteristics of chronic overactivity of the marrow.
Sickle cell anemia, which is another type of hereditary anemia, may also cause ballooning of ribs and findings of extramedullary hematopoiesis. However, its most common thoracic manifestation is pulmonary infection and complex pulmonary abnormalities causing acute chest syndrome.
References
1. Tunaci A et al. Imaging features of thalassemia. Eur Radiol 1999;9(9):1804-9.
2. Lonergan GL et al. Sickle cell anemia. RadioGraphics 2001;21(4);971-94
Keywords
Thalassemia, Thalassemia (beta thalassemia major), Bone, Extramedullary hematopoiesis,

No. of Applicants : 131

▶ Correct Answer : 52/131,  39.7%
  • - Yokohama-asahi-chuo-general hospital , Japan KYOKO NAGAI
  • - dayanand , India REENA GUPTA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - NIMS, Hyderabad , India AMIT DADHANIA
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Seoul Medical Center , Korea (South) TAERAN AHN
  • - Chungbuk National University Hospital , Korea (South) SOOJUNG LEE
  • - Other , Korea (South) SEONG SU KANG
  • - Other , Korea (South) LEE YOU JIN
  • - Soonchunhyang University Hospital Seoul , Korea (South) SUNG HWAN BAE
  • - Chungbuk National University Hospital , Korea (South) CHANGHOON OH
  • - privato , Italy VINCENZO ENZO GENCHI
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Pusan national university hospital , Korea (South) SeungHyun Lee
  • - Ajou University School of Medicine , Korea (South) YOOLIM BAEK
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - SNU Boramae Medical Center , Korea (South) KWANG NAM JIN
  • - Chung buk national university hospital , Korea (South) hong gwon Byun
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - , Korea (South) KIM JEONG MYEONG
  • - Chungbuk national university , Korea (South) Yong Hun Kim
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - , United States MAANSI P
  • - , United Arab Emirates MAHA JASEM HASAN
  • - Other , Korea (South) HAYEON LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Maimonides Medical Center , United States NAOMI TWERSKY
  • - , Korea (South) HYERIN KIM
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - GHICL , France MANUEL TOLEDANO
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - Konkuk University Medical Center , Korea (South) YONG WONN KWON
  • - DECRH, Fredericton , Canada RAM P GALWA
  • - , Korea (South) RANG LEE
  • - ICD,MCH CALICUT , India rikhy krishnan
  • - Ajou University Hospital , Korea (South) SEULGI YOU
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - , Korea (South) SUBIN HEO
  • - The University of Tokyo Hospital , Japan KAORU SUMIDA
  • - Seoul National University Hospital , Korea (South) SUNKYUNG JEON
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Pusan National University Yangsan Hospital , Korea (South) JUNMEE YOU
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - Pusan national university hospital , Korea (South) So min Park
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
▶ Correct Answer as Differential Diagnosis : 7/131,  5.3%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Kashan University of Medical Sciences, kashan , Iran EBRAHIM deleted RAZI
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - University of Utah , United States AKIHIKO SAKATA
  • - Manipal hospitals , India ELAKYA ARUL
▶ Semi-Correct Answer : 45/131,  34.4%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Korea University Guro Hospital , Korea (South) Bit Na Park
  • - Korea University Guro Hospital , Korea (South) PARK SOYEON
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Korea University Guro Hospital , Korea (South) GAYOUNG CHOI
  • - Kyeongpook National University Hospital , Korea (South) CHUNGEUN LIM
  • - Chonnam National University Hwasun Hospital , Korea (South) INSOO JANG
  • - Raja muthiah medical college , India ABIRAMI MAHADEVAN AM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , United States JITESH AHUJA
  • - , Saudi Arabia MUTHURAJAN PARAMASIVAM
  • - , India SANTOSH KUMAR PADHY
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - HMABB , Argentina NICOLAS MARTIN
  • - PRINCE SATTAM IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia ELBAGIR MOHAMED NASSIR
  • - Chonnam National University Hospital , Korea (South) GUNSU KIM
  • - Chonnam National University Hospital , Korea (South) KIM GO EUN
  • - The Jikei university , Japan TAKU GOMI
  • - Qatif Central Hospital , Saudi Arabia HANI MAKKY ALSALAM
  • - Asan Medical Center , Korea (South) HYOJUNG PARK
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - , Brazil HELOISA VICENTINI SANDRINI
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - HHS , Canada S LEE
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Samsung Medical Center , Korea (South) BODA NAM
  • -
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Santosh hospital,Bengaluru , India Pravin kumar Mahadevappa
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - GOLD CHILD & CHEST HOSPITAL tirunelvelli , India SARAVANAN M
  • - Korea University Guro Hospital , Korea (South) JINWOO HAN
  • - Asan Medical Center , Korea (South) Dabi Lee
  • - Private sector , Greece VASILIOS TZILAS
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Korea University Guro Hospital , Korea (South) HWANSEOK YONG
  • - Korea University Guro Hospital , Korea (South) Yoonmi Choi
  • - Korea University Ansan Hospital , Korea (South) CHERRY KIM
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