technetium-tc-99m-sulfur-colloid and beta-Thalassemia

Topics: Abdominal Pain; Aged; beta-Thalassemia; Diagnosis, Differential; Hematopoiesis, Extramedullary; Humans; Lumbosacral Region; Lymphoma; Male; Mononuclear Phagocyte System; Spine; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Extramedullary hematopoiesis (EMH) occurs as a compensatory mechanism for bone marrow dysfunction in severe thalassemia. In addition to the more common locations, such as liver, spleen and lymph nodes, a mass of EMH may occasionally occur in the thorax. Intrathoracic EMH is usually asymptomatic. A 69-year-old woman who initially presented with hematuria, dysuria, and left inguinal pain was found to have paravertebral masses in the thorax. Histopathologic examination of a CT-guided needle aspiration biopsy of the masses showed the presence of trilineage hematopoiesis. We present this unusual case, in which EMH was diagnosed by chance in an elderly patient with no symptoms related to thalassemia.

Topics: Aged; beta-Thalassemia; Biopsy, Needle; Cell Lineage; Female; Hematopoiesis, Extramedullary; Hematuria; Hepatomegaly; Humans; Incidental Findings; Mediastinum; Radiography, Interventional; Radiopharmaceuticals; Splenomegaly; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Abdominal Injuries; Adolescent; Adult; beta-Thalassemia; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Purpura, Thrombocytopenic, Idiopathic; Splenectomy; Splenosis; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Extramedullary hematopoiesis (EMH) refers to the production of blood cells outside the bone marrow and is a compensatory mechanism for bone marrow dysfunction. A 34 year-old female patient with beta thalassemia major was found to have multiple large, well-circumscribed radiopaque paravertibral mass lesions in chest radiography. Magnetic resonance imaging (MRI) of the thorax disclosed a right upper apical and two lower thoracic paraspinal mass lesions with heterogeneous isointensity on T1-weighted images and hypointensity on T2-weighted images. Because intrathoracic EMH is suspected in our case, which had obvious bone marrow dysfunction, radionuclide bone marrow scintigraphy is helpful in supporting the diagnosis. Tc99m sulfur colloid scintigraphy demonstrated three intense radioactive thoracic paraspinal mass lesions corresponding to the lesions seen on MRI. We believe whole body bone marrow scintigraphy with Tc99m sulfur colloid is the best convenient noninvasive method for supporting the diagnosis of EMH.

Topics: Adult; beta-Thalassemia; Bone Marrow; Female; Hematopoiesis, Extramedullary; Humans; Magnetic Resonance Imaging; Radiography, Thoracic; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Adult; beta-Thalassemia; Hematopoiesis, Extramedullary; Humans; Indium Radioisotopes; Male; Pelvis; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon