CTICasesThalassemia with Extramedullary Hematopoiesis
Imaging findings
A chest radiograph demonstrates expanded, remodeled ribs referred to as "canoe paddle ribs," alongside a triple-density contour along the mediastinum. A subsequent chest CT confirms a modeled and expanded appearance of the ribs and vertebrae. There is an exuberant, lobulated soft tissue mass in the paraspinal and posterior mediastinal spaces containing a mixture of soft tissue and macroscopic fat elements.
Key takeaways
Extramedullary hematopoiesis (EMH) is a compensatory response to chronic marrow-marrow depletion, typically seen in hemolytic anemias such as thalassemia. The paraspinal regions are classic locations for EMH, where the masses can expand dramatically. Following treatment, the active marrow elements within these masses often regress, though the fat content typically remains and can be identified on follow-up imaging.
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