Hematopoese extramedular: achados em tomografia computadorizada do tórax de 6 pacientes

Abstract

OBJETIVO: Apresentar os achados na tomografia computadorizada do tórax indicativos de hematopoese extramedular de seis pacientes. MÉTODOS: Foram estudadas, retrospectivamente, as tomografias de seis pacientes adultos-cinco homens e uma mulher-com idade média de 36,5 anos. Os exames foram analisados por dois radiologistas, de forma independente, e as decisões finais foram obtidas por consenso. RESULTADOS: O achado mais freqüente nas tomografias foi o de massas paravertebrais inferiores, de conteúdo heterogêneo (quatro pacientes). As tomografias de dois pacientes mostravam uma massa solitária parietal e pleural. CONCLUSÕES: A hematopoese extramedular apresenta aspectos na tomografia computadorizada fortemente sugestivos do diagnóstico que, quando correlacionados com a presença de doença hematológica de base, permitem, na maior parte dos casos, dispensar a comprovação histopatológica.

Paravertebral Mass in a Patient with Hemolytic Anemia: Computed Tomographic Findings

“…Extramedullary hematopoiesis occurs as a compensatory response in various congenital hemolytic anemias, such as thalassemia, sickle cell anemia and hereditary spherocytosis, as well as in myeloproliferative disorders, such as leukemia, lymphoma, myelodysplasia, and myelofibrosis [3, 5, 7, 8]. …”

“…Proliferation of embolized hematopoietic tissues from other areas, such as the spleen, can explain other heterotopic marrow foci [1, 2, 5, 8]. …”

“…On conventional radiology, IEH presents as lobulated, smoothly marginated, paravertebral masses, usually multiple and bilateral and caudal to the sixth thoracic vertebra, without calcifications or bone erosion [2, 5, 8]. The absence of bone destruction is important for the differential diagnosis with other posterior mediastinal lesions, especially neurogenic tumors [5, 8].…”

“…The absence of bone destruction is important for the differential diagnosis with other posterior mediastinal lesions, especially neurogenic tumors [5, 8]. Less frequently masses can also be found in the anterior mediastinum or in the pleura [1, 5]. Interstitial pulmonary involvement has also been reported in [3, 5].…”

“…Thoracic involvement is usually asymptomatic [1, 3]. Noninvasive studies, such as conventional radiology, computed tomography (CT), magnetic resonance imaging (MRI), or scintigraphy, can establish the diagnosis when characteristic radiological findings are present in the proper clinical setting [3, 5]. Because of the inherent risk of bleeding complications, tissue biopsy should be reserved for cases in which other causes of posterior mediastinal masses cannot be excluded [1, 4, 6].…”