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Weekly Chest CasesArchive of Old Cases

Case No : 708 Date 2011-05-23

  • Courtesy of Mi-Jin, Kang, MD. / Inje University, Sang-gye Paik Hospital
  • Age/Sex 47 / F
  • Chief ComplaintDizziness
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Extramedullary hematopoiesis
Radiologic Findings
Chest PA radiograph (Figure 1) shows a lobulated contour on the both side of paravertebral stripes. It also demonstrates marked cardiomegaly with pericardial effusion and collapse of the RML. The chest CT images (Figure 2-3) reveal cardiomegaly with pericardial effusion, homogeneously enhancing paraspinal masses, left side of T6-7 and both sides of T8-10 vertebral level. There are multiple GB stones with hepatosplenomegaly (Figure 4). She had an autoimmune hemolytic anemia and underwent splenectomy
Brief Review
Extramedullary hematopoiesis (EMH) is the proliferation of hematopoietic cells outside of the bone marrow in response to production of too few blood cells to satisfy the body’s demand.
Intrathoracic EMH may manifest as a paraosseous mass, interstitial pulmonary abnormality, pleural mass, or hemothorax, either alone or in combination.
Mediastinal lesions most commonly occur in the posterior mediastinum due to herniation of myeloid tissue through the thin cortical bone of the posterior ribs and/or activation of extramyeloid hematopoietic cells. The paraspinal masses and rib expansion are the most common manifestation of intrathoracic EMH.
The paraspinal masses have to be differentiated from lymphadenopathy and neurogenic tumors. Cases of EMH involving the pulmonary interstitium mimick an inflammatory or neoplastic diffuse interstitial process and have occasionally resulted in cardiopulmonary insufficiency. EMH usually regresses or disappears after treatment with blood transfusion and hydroxyurea, splenectomy in cases of spherocytosis, or radiation therapy.
References
1.Choi H, David CL, Katz RL, and Podoloff DA. Case 69: Extramedullary Hematopoiesis Radiology 2004; 231: 52-56.
Gupta P, Naran A, Auh YH, and Chung JS. Focal Intrahepatic Extramedullary Hematopoiesis Presenting as Fatty Lesions Am. J. Roentgenol. 2004; 182: 1031 - 1032.
2.Chang CC, WU MM, Chao C, Vang VT, Tyan YS. Focal Tumor-like Splenic Extramedullary Hematopoiesis: a case report Chin J Radiol 2004; 29: 105-108.
3.Yahya M. Berkmen and Benjamin A. Zalta. Case 126: Extramedullary Hematopoiesis Radiology 2007; 245: 905-908
Keywords
mediastinum, metabolic ans storage,

No. of Applicants : 110

▶ Correct Answer : 53/110,  48.2%
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Seoul National University Hospital , Korea (South) Sung Ui Shin
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Okayama University , Japan Akihiro Tada
  • - University of British Columbia , Canada Amr Ajlan
  • - Teleradiology solutions , India harish bhambore
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Korea univ. hospital, radiology department , Korea (South) Choo jiyung
  • - Assam Medical college , India samudra borah
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - yeong gwang general hospital , Korea (South) Mokhee Kim
  • - SMC , Korea (South) Yi Kyung Kim
  • - University of Rochester Medical Center , United States Hongju Son
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Armed Forces Yangju Hospital , Korea (South) Ho-Joon Lee
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Radiologie Brabois adultes , France ROPION helene
  • - Calcutta Heart Research Centre, Kolkata , India Pankaj Nagori
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - DongA University hospital , Korea (South) Jiyoung Kang
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - HSC , Brazil Diogo Pinheiro
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Istanbul , Turkey Armagan Sarac
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - chp st martin , France Mariotte benoit
  • - Seoul St Mary Hospital , Korea (South) Chaehun Lim
  • - Mackay Memorial Hospital, Taipei , Taiwan Sheng-Yeh Shen
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - soon chun hyang, seoul , Korea (South) Yoo Na Kim
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Mallinckrodt Institute of Radiology , United States Travis Henry
  • - Hopital Louis Pradel Lyon , France Clement Proust
  • - Ospedale di Forl� , Italy Edoardo Cavigli
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae Wook Yeh
  • - IRSA , France jean-luc BIGOT
  • - DCA, , India Rajesh Gothi
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Kizawa memorial Hospital , Japan Yo Kaneko
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
▶ Correct Answer as Differential Diagnosis : 10/110,  9.1%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Saga University , Japan Ryoko Egashira
  • - CHRU lille , France manuel toledano
  • - Shree Diagnostics , India amol jagdale
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - NTUH , Taiwan Kuei-pin Chung
  • - Kobe City Medical Center General Hospital , Japan Hitomi Nagano
  • - McGill University , Canada Sean Carr
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
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