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Weekly Chest CasesArchive of Old Cases

Case No : 898 Date 2015-01-12

  • Courtesy of Yoonyoung Choi, Kun Il Kim / Pusan National University, Yangsan Hospital
  • Age/Sex 77 / M
  • Chief ComplaintDiziness
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Extramedullary hematopoiesis (EMH)
Radiologic Findings
Axial and coronal chest CT images (Figures 1 & 2) demonstrate a multilobulated, homogeneously enhancing mass along the right side of T8-11 vertebral body. No significant interval change was seen, compared to CT images obtained 2 years ago (not shown). PET-CT (Figure 3) demonstrate no FDG uptake. The patient had been diagnosed as myelodysplastic syndrome (MDS) on bone marrow biopsy, and the paraspinal mass biopsy revealed ‘Mainly bone marrow with hematopoietic cells’.
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. This is caused by either bone marrow replacement disease (myelofibrosis or chronic myelogenous leukemia) or hemolytic anemia (thalassemia, sickle cell anemia, or hereditary spherocytosis). The liver, spleen, kidney, lymph nodes, and posterior mediastinum are the most common sites of EMH.
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. EMH usually regresses or disappears after treatment with blood transfusion and hydroxyurea, splenectomy in cases of spherocytosis, or radiation therapy.
Please refer to
Case 598, Case 708,
References
1. Yeom SY, Lim JH, Han KN, Kang CH, Park IK, Kim YT. Extramedullary Hematopoiesis at the Posterior Mediastinum in Patient with Hereditary Spherocytosis: A Case Report. Korean J Thorac Cardiovasc Surg. Apr 2013; 46(2): 156–158.
2. Yahya M. Berkmen and Benjamin A. Zalta. Case 126: Extramedullary Hematopoiesis Radiology 2007; 245: 905-908

Keywords
Paravertebral, Others,

No. of Applicants : 72

▶ Correct Answer : 43/72,  59.7%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - SNUH , Korea (South) Eui Jin Hwang
  • - radiologist, aditya imaging centre , India vivek patel
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - �stanbul , Turkey Ayhan Yilmaz
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Tong young Red cross hospital , Korea (South)
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Niigata University , Japan Atsushi Uehara
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - alzahra , Iran johary
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - CLCC Rennes , France nicolas gautier
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - GHICL , France manuel toledano
  • - Vikram hospital , India Pravin Mahadevappa
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - university of montreal , Canada Andrei Gorgos I
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - medical university of isfahan , Iran pouya akbari
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Haeundae Paik Hospital , Korea (South) In Chul Nam
  • - Hanyang University Guri Hospital , Korea (South) Seung Hyun Kim
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - University of Tsukuba Hospital , Japan Sodai Hoshiai
  • - VHS medical center , Korea (South) Seong hee Jeon
  • - VHS medical center , Korea (South) Keuntak Roh
  • - Severance hospital , Korea (South) SeungHyun Park
  • - IRSA La Rochelle , France Denis Chabassiere
  • - CHU Poitiers , France CHAN paul
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - CHU POITIERS , France SZTARK Guillaume
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Medicheck health care , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 11/72,  15.3%
  • - Kyoto University , Japan Akihiko Sakata
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - University of British Columbia , Canada Amr Ajlan
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
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