MR of extramedullary hematopoiesis causing cord compression in beta-thalassemia.

A 30-year-old woman presented with back pain, weakness and numbness in both lower extremities, and difficulty initiating voiding. The patient was diagnosed at age 3 with beta-thalassemia intermedia. Physical examination revealed frontal bossing, a prominent mandible, T 4-level tenderness, decreased strength, light touch, pin prick and temperature in both lower extremities, abdomen and back with a T7-T9 level , and decreased vibratory and position sense in both toes. Bilirubin was 2.3/0.3 mg% with a serum iron of 241 . Emergency magnetic resonance (MR) was performed of the entire spine (Figs. 1 and 2). This was followed by MR of the brain (Fig. 3). Intravenous dexamethasone and radiation therapy was initiated emergently. The patient's lower extremity strength improved and sensation was regained. One year later, she returned with similar complaints and MR demonstrated a recurrent posterior epidural mass compressing the spinal cord from T6-T9. Discussion