Perirenal Extramedullary Hematopoiesis

Cheng, Yingnan; Ting, I-Wen

doi:10.1056/nejmicm1700379

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“…Contrast-enhanced CT of the abdomen in the previous studies identified homogenous, hypodense non-enhancing rind-like soft-tissue masses in the perinephric spaces as observed in our case [ 4 , 9 ]. In a previous case, MRI was performed in a patient with perirenal EMH [ 10 ], and areas of EMH show a T1-low and a T2-high signal [ 11 ]. EMH, as a cause of abnormal perirenal shadows, can be confirmed with MRI.…”

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confidence: 99%

A case of perirenal extramedullary hematopoiesis in a patient with primary myelofibrosis

et al. 2017

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Extramedullary hematopoiesis (EMH) is hematopoiesis in organs outside the bone marrow and most frequently occurs in the liver, spleen, and lymph nodes. We report a case of perirenal EMH revealed by kidney biopsy in a patient with primary myelofibrosis. We observed only bilateral kidney enlargement with plain computed tomography (CT) and ultrasonography before obtaining a renal biopsy. We obtained a percutaneous biopsy from the lower pole of the left kidney using ultrasonographic guidance. Ultrasonography just after the renal biopsy revealed no bleeding around the kidney. However, early the next morning, the patient developed severe hemorrhagic shock. Contrast-enhanced CT at that time revealed a massive hematoma in the left posterior perirenal space and bilateral abnormalities of the perirenal soft tissues. In patients with primary myelofibrosis, if plain CT shows an abnormal renal enlargement, EMH should be considered. In addition, a contrast-enhanced CT should be obtained before performing a percutaneous renal biopsy to assess for the possibility of perirenal EMH in these patients.

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