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Weekly Chest CasesArchive of Old Cases

Case No : 1276 Date 2022-04-04

  • Courtesy of Jee Hye Hur / Hanil General Hospital
  • Age/Sex 66 / M
  • Chief ComplaintKnown malignant melanoma in left 4th finger, for metastasis work-up
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Extramedullary hematopoiesis
Radiologic Findings
Fig 1-3. Contrast-enhanced CT scans show three uniformly enhancing paraspinal masses with no bony erosion.
Brief Review
This patient had anemia and splenomegaly.
On surgical specimen, the mass reveals extramedullary hematopoiesis.
The most common manifestation of extramedullary hematopoiesis (EMH) in the chest is paraspinal masses, which are typically discovered incidentally. Paraspinal masses are the most common site of EMH after hepatosplenomegaly and the most common site to present as a mass. Thoracic masses in the chest are frequently associated with thalassemia. The thoracic paraspinal masses of EMH are typically bilateral, smooth-surfaced, soft-tissue masses that contain areas of fat attenuation and do not calcify. The presence of fat attenuation within the masses most likely represents non-active lesions (akin to yellow marrow), whereas enhancement is more likely to be present in actively haematopoietic masses (akin to red marrow). Paravertebral masses are much more common in the thorax than in the abdomen or pelvis. The differential diagnosis of masses in the posterior mediastinum is led by neurogenic tumours and lymphoma, which can often have a similar appearance. Unlike lymphoma, EMH will present with bilateral masses and no soft-tissue connection or isthmus between the two masses. Neurogenic tumours are more commonly associated with osseous erosion. Castleman's disease is an additional possible differential diagnosis; however, the heterogeneity of masses associated with EMH is a key discriminator.
References
1. Roberts AS, Shetty AS, Mellnick VM, Pickhardt PJ, Bhalla S, Menias CO. Extramedullary haematopoiesis: radiological imaging features. Clin Radiol. 2016 Sep;71(9):807-14.
Please refer to
Case 1011 Case 898 Case 708 Case 598
Keywords
Extramedullary Hematopoiesis,

No. of Applicants : 124

▶ Correct Answer : 103/124,  83.1%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - No.2 Hospital ZiGong , China ZHOU XIA
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Chonnam National University Hospital , Korea (South) ARA A CHO
  • - Ajou University Hospital , Korea (South) SUNG HYUN AN
  • - Chungnam National University Hospital , Korea (South) MI HYUN KANG
  • - , France ANNE-LAURE LEJEUNE
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Chungbuk National University Hospital , Korea (South) HOSIG JANG
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Japan CHIAKI SATO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Chonnam National University Hwasun Hospital , Korea (South) HONG SEOK CHOI
  • - , Korea (South) CHANGSU KIM
  • - Other , Korea (South) HWANGHEE JO
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Asan Medical Center , Korea (South) MINSEON KIM
  • - , China FANG YING GEN
  • - Chonbuk National University Hospital , Korea (South) YONG HWAN JO
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Osaka University , Japan AKINORI HATA
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Chungnam National University Hospital , Korea (South) HYUN JAE LIM
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - , Korea (South) MINJI KIM
  • - , Korea (South) SUNHYANG LEE
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - , Korea (South) HYEWON CHOI
  • - , Korea (South) HYUNSEUNG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - , Korea (South) JAYOUNG MOON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chonnam National University Hwasun Hospital , Korea (South) MYUNG WON SONG
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Chungbuk National University Hospital , Korea (South) JUNGHYUN LEE
  • - , Korea (South) CHAEHUN LIM
  • - , Korea (South) YEONG UK HWANG
  • - Other , Korea (South) SEUNGHYUN LIM
  • - Other , Korea (South) MARI A
  • - , France LOIC BOISLIVEAU
  • - , United States HIROAKI TAKAHASHI
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - , Argentina MARCOS MESTAS NUEZ
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - , Qatar NABIL SHERIF MAHMOOD
  • - Chungbuk National University Hospital , Korea (South) CHANSEOP KIM
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Chungbuk National University Hospital , Korea (South) PARK JUN HYEON
  • - Manipal hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - TB centre kasaragod. , India rikhy krishnan
  • - Asan Medical Center , Korea (South) BYUNGSOO IM
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Chonnam National University Hospital , Korea (South) SOMIN LEE
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Hanyang University Hospital , Korea (South) SUNJIN RYU
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Sotiria Hospital, Athens , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - , Korea (South) WONJU HONG
  • - , Korea (South) HM PARK
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Graduate School of Medicine, Kyoto University , Japan YANG WANG
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 8/124,  6.5%
  • - Korea University Guro Hospital , Korea (South) SEOKYOUNG LEE
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - , Korea (South) JIN YOUNG LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Other , Korea (South) SEONG WON JANG
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - Other , Korea (South) KYU-CHONG LEE
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
▶ Semi-Correct Answer : 1/124,  0.8%
  • - algeria , Algeria ZAKARIA CHERAGA
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