Long segment spinal epidural extramedullary hematopoiesis
A 25-year-old male with known thalassemia intermedia, who had never previously required a blood transfusion, presented with a 1-month history of stiffness and weakness in both lower extremities without accompanying sphincteric dysfunction. The general physical examination revealed palpable splenomegaly, while the neurological assessment demonstrated localized tenderness over the D5 level, with attendant 4/5 weakness in both lower extremities, hyperactive bilateral Patellar and Achilles reflexes with bilateral Babinski responses, and a graded sensory loss to pin appreciation below D5.\nThe magnetic resonance imaging (MRI) of the thoracic spine revealed a posterior, isointense soft tissue epidural mass extending from D2 to D12 on both pulse sequences (T1, T2), suggestive of “red marrow” [Figures and ]. The cord appeared compressed anteriorly, thinned, and atrophic. The vertebral bodies displayed isointense to hypointense signals on both T1WI and T2WI images along with coarsening of the trabecular pattern; these findings suggested a hypercellular bone marrow consistent with EMH. Of interest, the cervical spine MR was normal.\nThe patient was given multiple blood transfusions and it was decided to repeat a MRI after a period of 8 weeks and further treatment plan will be decided based on the MRI findings.