Extensive Extramedullary Hematopoiesis in Thalassemia: Soft Tissue Uptake on 99mTc-MDP SPECT/CT

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Abstract

We report the case of a 45-year-old man with thalassemia major referred for a bone scan as a workup for generalized bone pain. Tc-MDP SPECT CT showed multiple elongated soft tissue masses along the inner aspects of ribs and along both sides of dorsal spine with calcification and mild tracer uptake. There was also a large lobulated presacral soft tissue mass displacing the bladder and involving the adjacent pelvic bone. Biopsy of mildly avid tracer uptake in pelvic soft tissue mass was extramedullary hematopoiesis confirmed by biopsy.


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References

  1.  
    1. Georgiades CS, Neyman EG, Francis IR, et al. Typical and atypical presentations of extramedullary hemopoiesis. AJR Am J Roentgenol. 2002;179:1239–1243.
  2.  
    1. Rivella S. The role of ineffective erythropoiesis in non–transfusion-dependent thalassemia. Blood Rev. 2012;26:S12–S15.
  3.  
    1. Smith PR, Manjoney DL, Teitcher JB, et al. Massive hemothorax due to intrathoracic extramedullary hematopoiesis in a patient with thalassemia intermedia. Chest. 1988;94:658–660.
  4.  
    1. Roberts AS, Shetty AS, Mellnick VM, et al. Extramedullary haematopoiesis: radiological imaging features. Clin Radiol. 2016;71:807–814.
  5.  
    1. Haidar R, Mhaidli H, Taher AT. Paraspinal extramedullary hematopoiesis in patients with thalassemia intermedia. Eur Spine J. 2010;19:871–878.
  6.  
    1. Maffione AM, Rampin L, Rossella P, et al. False-positive 18F-FDG PET/CT due to filgrastim that induced extramedullary liver hematopoiesis in a Burkitt lymphoma. Clin Nucl Med. 2018;43:e130–e131.
  7.  
    1. Mesurolle B, Sayag E, Meingan P, et al. Retroperitoneal extramedullary hematopoiesis: sonographic, CT, and MR imaging appearance. AJR Am J Roentgenol. 1996;167:1139–1140.
  8.  
    1. Gnanasegaran G, Cook G, Adamson K, et al. Patterns, variants, artifacts, and pitfalls in conventional radionuclide bone imaging and SPECT/CT. Semin Nucl Med. 2009;39:380–395.