Imaging Pearls ❯ Chest ❯ Pleural Masses
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- “Thalassemia is an inherited multisystemic disorder with skeletal and non-skeletal manifestations. Plain-film radiography is generally adequate in defining the routine osseous abnormalities of thalassemia. The CT and MRI techniques can document the abnormal deposition of iron, ExmH, and bone marrow changes.”
Imaging features of thalassemia
M. Tunacõ, A. Tunacõ, G. Engin et al.
Eur. Radiol. 9, 1801-1809 (1999) - “Extramedullary haematopoiesis (EMH) is the production of blood elements outside of the normal location. EMH occurs when there is either insufficient production or poor quality of the blood elements produced. Insufficient production of blood elements occurs when there is replacement of the bone marrow, most commonly caused by myelofibrosis (the most common cause of EMH overall), diffuse metastatic disease, and leukaemia.Examples of insufficient quality of blood products include haemoglobinopathies, most commonly sickle cell anaemia and thalassemia.”
Extramedullary haematopoiesis: radiological imaging features
A.S. Roberts et al.
Clinical Radiology 71 (2016) 807-814 - “EMH is a reactive or compensatory mechanism of new extramarrow blood element formation because of chronically ineffective erythropoiesis. It is usually seen in paraspinal areas, the spleen, liver, and lymph nodes, although a spectrum of other anatomical sites has been reported, as described previously. The rarity of the disease and the nonspecific findings hinder initial consideration of the diagnosis. Physicians need to be aware of this possibility to initiate appropriate diagnostic and treatment interventions. Knowledge of the patients’ clinical history is absolutely essential. A history of a disease or condition resulting in chronically ineffective hemopoiesis should prompt the physician to have a high index of suspicion.”
Extramedullary Hemopoiesis
Eleni Orphanidou-Vlachou et al.
Semin Ultrasound CT MRI 35:255-262 - “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.”
Extramedullary haematopoiesis: radiological imaging features
A.S. Roberts et al.
Clinical Radiology 71 (2016) 807-814 - “The paravertebral region is a very common site (probably the most common) for extramedullary hemopoietic tissue, and when this happens, it presents as large multilobed, paravertebral thoracic masses. They rarely cause significant symptoms, such as dyspnea, pleural effusion, or hemothorax. If paraspinal hemopoietic tissues extend into the central canal, neurologic symptoms of spinal cord compression are observed.”
Extramedullary Hemopoiesis
Eleni Orphanidou-Vlachou et al.
Semin Ultrasound CT MRI 35:255-262 - “Thalassemia is a kind of chronic, inherited, microcytic anemia characterized by defective hemoglobin synthesis and ineffective erythropoiesis. In all thalassemias clinical features that result from anemia, transfusional, and absorptive iron overload are similar but vary in severity. The radiographic features of b-thalassemia are due in large part to marrow hyperplasia. Markedly expanded marrow space lead to various skeletal manifestations including spine, skull, facial bones, and ribs. Extramedullary hematopoiesis (ExmH), hemosiderosis, and cholelithiasis are among the non-skeletal manifestations of thalassemia.”
Imaging features of thalassemia
M. Tunacõ, A. Tunacõ, G. Engin et al.
Eur. Radiol. 9, 1804±1809 (1999)
"Solitary fibrous tumors tend to be well defined, ovoid, heterogeneously enhancing lesions. MRI characteristically depicts areas of low signal intensity that correspond to dense collagen. The findings of lesion multiplicity and hypermetabolism on PET images should raise the suspicion of malignancy."
Imaging Features of Solitary Fibrous Tumors
Ginat DT et al.
AJR 2011;196:487-495- Solitary Fibrous Tumors: Locations
- Pleura
- Spine
- Head and neck
- Lung
- Pancreas
- Liver
- Kidney and retroperitoneum - Solitary Fibrous Tumors: Facts
- Fibrous tumors of mesenchymal origin
- Can be benign or malignant
- Most commonly located in the pleura
- Can be associated with hypoglycemia secondary to production of insulin like growth factor, osteoarthropathy, arthralgia, and clubbing