Number 08-22: A Segmented thoracic mass
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Number 08-22: A Segmented thoracic mass

Case from: Ferdinando Pasquale, Maciej Garbowski, John Porter, Mark Westwood. Departments of Cardiology and Haematology The Heart Hospital and UCLH, London UK

History: A 32 yrs old man was referred for assessment of iron loading by measurement of cardiac T2*. Past medical history of transfusion dependent thalassaemia (thalassemia) major and chronic iron chelation therapy.

ECG: sinus rhythm, complete left bundle branch block. Cine CMR: LV dilatation with preserved systolic function. Mild left atrial dilatation. T2* analysis showed no cardiac or iron overload.

Extra-cardiac anatomy: Large bilateral paravertebral masses extending 4 vertebral bodies (R) and 2(L), maximum size 40x50x70mm. Coronal and sagital views demonstrate segmental stripes within the masses.




Interpretation: This is the classical appearance of thoracic paravertebral extramedullary hematopoiesis. The classical segmental striping is seen in this case. Other mediastinal masses can be striped (eg massive confluent lymphadenopathy in Hodgkins). Extramedullary hemopoiesis is less common now in many parts of the world due to blood transfusions. Rarely, this tumor-like mass can cause spinal cord compression requiring radiotherapy or surgical removal.

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