Imaging studies in extramedullary hematopoiesis of the spleen

Matteuzzi, Benedetta; Pieri, Lisa; Lisi, F.; Galimberti, Sara; Campani, Daniela; Colagrande, Stefano

doi:10.1007/s00277-013-1802-5

Cited by 2 publications

(3 citation statements)

References 6 publications

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“…In humans, the EMH in the spleen can present as a focal mass, but is much less common than the diffuse presentation 10,11 and CT appearance of EMH can consist of heterogeneous, hypovascular soft-tissue masses 11 or of well-defined, highly and heterogeneously enhanced lesion. 16,17 Also, in this study, both hypervascular and hypovascular masses were seen, and this result is in agreement with previous study in dogs in which malignant and non-malignant splenic masses showed variable CT features. 6 In another study, benign splenic masses showed homogeneous normal enhancement while malignant masses were heterogeneously poorly to remarkably enhancing, 7 although in these studies only nodular hyperplasia was described and no patients with extramedullary hematopoiesis were included.…”

Section: Discussionsupporting

confidence: 93%

Splenic extramedullary hematopoiesis in dogs is frequently detected on multiphase multidetector‐row CT as hypervascular nodules

Cordella

Caldín

Bertolini

2020

Vet Radiology Ultrasound

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Extramedullary hematopoiesis (EMH) is the formation and development of blood cells outside the bone marrow, and in dogs it frequently occurs in the spleen. Although splenic EMH is a relatively common condition, data regarding its appearance in veterinary medicine are lacking. Our aim was to describe different multidetector computed tomographic (MDCT) features of splenic EMH in dogs. In this descriptive retrospective study, dogs with cytological diagnosis of splenic EMH and three‐phase MDCT study of the abdomen were included. Multi‐detector CT findings recorded were splenomegaly, appearance of the parenchyma, and mean attenuation of the spleen and lesions. Out of 89 dogs included, 55 (62%) presented multifocal nodular aspect, 14 (16%) mass, 12 (13%) diffuse heterogeneous parenchyma, and eight (9%) normal spleen. Most lesions were hyperattenuating to the parenchyma in the arterial (57/89, 64%) and portal (59/89, 66%) phases; whereas in the interstitial phase only 40 of 89 (45%) were hyperattenuating. The mean attenuations of the lesions were higher compared to the values of the adjacent spleen, and the difference of the mean attenuation between the hyperattenuating lesions and the parenchyma was significantly higher in arterial and portal phases than in interstitial phase (P < .0001). The most frequent MDCT aspect of splenic extramedullary hematopoiesis consists of multiple nodules hyperattenuating to the normal spleen, best visualized in the arterial and portal phases.

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Section: Discussionsupporting

confidence: 93%

Splenic extramedullary hematopoiesis in dogs is frequently detected on multiphase multidetector‐row CT as hypervascular nodules

Cordella

Caldín

Bertolini

2020

Vet Radiology Ultrasound

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“…Computed tomography revealed intra-abdominal hematoma and caliber changes in the small intestine (a arrowheads). The small intestine was obstructed by the intra-abdominal hematoma (b), and intestinal obstruction was released by removal of the hematoma (c) intra-abdominal region, and although quite rare, EMH has been reported to present as a focal mass in the spleen [1,[3][4][5][6][7][8], which could induce short-term enlargement. Regarding the image findings, it has been reported that EMH presents as homogenous or slightly heterogeneous low-density lesions with little or no enhancement on CT [3,[5][6][7], which are visualized with low to iso-intensity on T1WI and low to high intensity on T2WI [4,7].…”

Section: Discussionmentioning

confidence: 99%

“…As these findings are nonspecific, EMH is difficult to distinguish from focal splenic tumors such as hemangioma, hamartoma, littoral cell angioma, lymphangioma, inflammatory pseudotumor, malignant lymphoma, metastases, or hemangiosarcoma [9] by imaging findings alone. This is because the image patterns of focal splenic tumors overlap between these tumors, and CT and MRI findings have variable characteristics depending on the status of EMH [4,7,8]. However, the combination of these imaging findings and medical history, including history of hematological disorders, hemolytic anemia, thalassemia, myelofibrosis, leukemia, or ET, could suggest the possibility of EMH.…”

Section: Discussionmentioning

confidence: 99%

A focal extramedullary hematopoiesis of the spleen in a patient with essential thrombocythemia presenting with a complicated postoperative course: a case report

et al. 2021

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Background Extramedullary hematopoiesis is a compensatory response occurring secondary to inadequate bone marrow function and is occasionally observed in essential thrombocythemia (ET). This disease usually presents as multifocal masses in the paravertebral or intra-abdominal region; however, formation of a focal mass in the liver or spleen is rare. In addition, ET is characterized by increased platelet count and shows a tendency toward thrombosis and, occasionally, bleeding. Serious bleeding is common in ET patients, caused by the decrease in or abnormalities of von Willebrand factor (vWF) as a consequence of the precipitous rise in platelets. Therefore, strict management of platelet count using medication is crucial in patients with ET who require invasive procedures, especially splenectomy. Case presentation A 68-year-old man with ET was found to have an enlargement of a focal splenic tumor. Imaging findings revealed that the tumor was likely a hemangioma or hamartoma; however, the possibility of malignant disease could not be completely ruled out because of short-term tumor enlargement, and we conducted a splenectomy. The surgery was uneventful, but the patient presented with severe polycythemia and vWF abnormalities postoperatively, which resulted in bleeding from the drain insertion site and wound, epistaxis, and hemorrhoidal bleeding. Three months after discharge, polycythemia still persisted and the level of vWF gradually decreased. With a decrease in vWF, the patient suffered from an increased bleeding tendency. Therefore, the patient has been referred for bone marrow transplantation and is currently awaiting a suitable donor. Conclusions Extramedullary hematopoiesis should be listed as a differential diagnosis of focal enlarged splenic tumors, especially in patients with myeloproliferative disorders. Additionally, in splenectomy for ET patients, careful perioperative management taking into consideration the conflicting features of a tendency toward thrombus formation and bleeding is necessary.

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Imaging studies in extramedullary hematopoiesis of the spleen

Cited by 2 publications

References 6 publications

Splenic extramedullary hematopoiesis in dogs is frequently detected on multiphase multidetector‐row CT as hypervascular nodules

Splenic extramedullary hematopoiesis in dogs is frequently detected on multiphase multidetector‐row CT as hypervascular nodules

A focal extramedullary hematopoiesis of the spleen in a patient with essential thrombocythemia presenting with a complicated postoperative course: a case report

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