Abstract

Introduction: Extramedullary hematopoiesis is the production of blood outside the bone marrow, which is characterized by increased production of one or more types of blood cells. Intrathoracic extramedullary hematopoiesis usually causes lobulated paravertebral masses with unilateral or bilateral, smooth, sharp edges, and is sometimes accompanied by subpleural and paracostal masses. In this case, we aimed to present the MRI findings of intraspinal extradural hematopoiesis and extramedullar hematopoiesis (EMH) of a patient with lung cancer. Case: The patient is followed up in the clinic with lung cancer and vertebra metastases. A mass lesion was observed in the prevertebral space extending from the middle thoracic region to the lumbar region, uniformly limited, showing contrast enhancement after intravenous contrast agent (IVCA) injection 2.5 cm in the thickest place, and in the soft tissue intensity that partially surround the azygos vein and thoracic aorta, consistent with extramedullary hematopoiesis. There was an appearance of 6.5 mm in the thickest part of the spinal canal, which was observed in the spinal canal during the C5-T2 vertebrae, posteriorly, extra-dural, compressing from the posterior to the dura, diffusing contrast enhancement in the sequences taken after IVCA injection. Appearance was evaluated in favor of intraspinal, extradural hematopoiesis. Discussion: Spinal epidural space is a closed anatomic space between the dura mater and the bony spinal canal. Magnetic Resonance Imaging (MRI) is the imaging modality of choice to assess the spine and pathologies of posterior spinal epidural space. The clinical details, laboratory parameters and imaging characteristics help arrive at a specific diagnosis. Extramedullary hematopoiesis appears as well-defined lobulated masses embedded in the epidural space. These show isointense signal to cord on T1W, variable signal on T2W, and none-to minimal post-contrast enhancement. Conclusion: Recognition of spinal cord EMH requires prompt physical examination and MRI for accurate diagnosis.