A 26-yr-old female with persistent cough. Intrathoracic extramedullary haematopoiesis in a patient with beta-thalassemia intermedia.

A 26-yr-old female was referred to the Chest Dept of the Pamukkale University Medical School, Turkey, for the investigation of coughing and abnormal chest roentgenogram. She suffered flu 3 weeks prior to this and her coughing was persisting since then. She denied fever, phlegm, dyspnoea, wheeze, night sweats and haemoptysis. Before a splenectomy at aged 18 yrs, blood transfusions had been applied monthly. Physical examination revealed a blood pressure of 120/ 80 mmHg, pulse rate of 96 beats per min, respiratory rate of 21 breaths per min and marked hepatomegaly. Chest examination results were normal. Haematological examination showed a haemoglobin level of 1.38 mmol?L (89.3 g?L), haematocrit value of 0.19, mean corpuscular volume of 91.4 fL, mean corpuscular haemoglobin concentration of 466 g?L, red blood cell count of 2.1610 cells?L, reticulocyte count of 0.14, white blood cell count of 23610 cells?L, and platelet count of 1072610 platelets?L. Serum biochemical findings were as follows: aspartate aminotransferase 85 U?L, alanine aminotransferase 84 U?L, blood urea nitrogen 1.33 mmol urea?L, total protein 73 g?L, total bilirubin 30.8 mmol?L, iron 36.7 mmol?L, ferritin 2.3 g?L, and total iron binding capacity 40.3 mmol?L. The chest radiographs (fig. 1a and 1b), computed tomography (CT) of the chest (fig. 2), thoracic single photon emission computed tomography (SPECT) study with TC99M (fig. 3) and peripheral blood smear (fig. 4) were as shown.