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Mass-like extramedullary hematopoiesis: imaging features.

Andrew W Ginzel¹, Mark J Kransdorf, Jeffrey J Peterson

¹Synergy Radiology Associates, P.A., 7026 Old Katy Road #276, Houston, TX 77024, USA.

Skeletal Radiology

|November 22, 2011

Summary

Mass-like extramedullary hematopoiesis (EMH) often appears as multiple, fat-containing lesions on the axial skeleton. Consider EMH in patients with predisposing conditions when these imaging features are present.

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Area of Science:

Radiology
Hematology
Pathology

Background:

Extramedullary hematopoiesis (EMH) is the formation of blood cells outside the bone marrow.
Mass-like EMH can mimic other neoplastic or inflammatory conditions, posing diagnostic challenges.

Purpose of the Study:

To describe the imaging characteristics of mass-like extramedullary hematopoiesis (EMH).
To identify key imaging features for confident diagnosis of EMH.
To correlate imaging findings with associated clinical conditions and disease incidence.

Main Methods:

Retrospective review of 44 patients with EMH, focusing on 12 with focal mass-like lesions.
Analysis of CT and MR imaging characteristics of the identified lesions.
Review of clinical presentations and predisposing conditions for EMH.

Main Results:

Mass-like EMH commonly presents as multiple, fat-containing lesions along the axial skeleton (90% of axial masses).
Paraspinal (80%) and presacral (40%) masses were also frequent findings.
Predisposing conditions, including anemias (45%) and myelofibrosis/myelodysplastic syndromes (36%), were present in most patients.

Conclusions:

Multiple, fat-containing lesions on the axial skeleton are characteristic imaging features of mass-like EMH.
EMH should be strongly considered in the differential diagnosis when these features are observed.
The presence of a predisposing medical condition increases the likelihood of EMH.