A calcified mass in the spinal canal of a patient with β-thalassemia major

A thirty-nine-year-old patient with β-thalassemia major had complained for 3 months of weakness in both legs, more marked proximally, reduced thermo-dolorific sensitivity bilaterally, and oedema of the feet and ankles. The symptoms worsened rapidly and within a month the patient was unable to walk. Mean pretransfusional hemoglobin in the past year was 8,5 g/dL. Due to severe and frequent episodes of atrial fibrillation the patient was on therapy with oral anticoagulants. Two years prior to the present episode, the patient underwent the evacuation of an intracranial subdural hematoma in the left fronto-parietal area. An unenhanced thoraco-lumbar Computed Tomography (CT) scan showed a well-circumscribed, oval, homogeneously hyperdense extramedullary mass lesion within the vertebral canal at D4-D5 level associated with a spinal cord compression (Figure). Magnetic Resonance Imaging (MRI) could not be performed because the patient carried a cardiac pace-maker. A scintigraphy with Tc99 marked red blood cells did not demonstrate the presence of functioning extramedullary erythropoietic tissue. The rapid progression of symptoms required a therapeutic laminectomy that evidenced a brownish, crumbly extramedullary mass that was completely removed. The post operative course was uneventful and the patient’s neurological symptoms slowly regressed.