Sepideh Sefidbakht, MD

A 45-year old-woman presents with nonspecific pelvic pain and fullness. Following this MRI, patient had a cystoscopy and biopsy which revealed proliferative cystitis. Coronal and sagittal T2 weighted images as well as axial T1 weighted images with and without fat saturation are shown.




Pelvic lipomatosis is a rare entity characterized by benign mature fatty tissue insinuating the perivesical/perirectal spaces in the pelvic cavity. This condition is mostly seen in African American men. It usually remains asymptomatic until late in the disease when proliferative cystitis (a premalignant condition) or obstructive uropathy develops. Pear-shaped bladder and anterosuperior displacement of the bladder, prostate and seminal vesicles can occur.

Proliferative cystitis is seen in up to 80 percent of patients with pelvic lipomatiosis. The pathogenesis has been speculated to be obstruction of venous and lymphatic drainage of the bladder. In many cases, resulting carcinomas are usually adenocarcinomas mandating cystectomy.


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B, BaÅ¡ic-Jukic NC, Å oÅ¡ic HA.   Pelvic and retroperitoneal lipomatosis: case report. 

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 ed. Philadelphia, PA: Mosby, Elsevier. 2009; pp 1953-2040.

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45-year-old woman with nonspecific pelvic pain and fullness, after MRI underwent cystoscopy and biopsy which revealed proliferative cystitis.

Image IQ: 45-year-old Woman, Nonspecific Pelvic Pain and Fullness

A 25-year-old man presents with progressive lower extremity weakness. Thoracic spine MR image (sagittal T1W and axial T2W) is shown.

Click on the images to enlarge.Click on the images to enlarge.


Extramedullary hematopoiesis  (EMH) typically occurs as a compensatory response to chronic anemia in a patient with chronic bone marrow insufficiency. This condition is seen commonly in patients with thalassemia presenting as masses in association with bone marrow expansion. These masses are frequently located in the paravertebral regions and have been reported to show various signal intensities in both T1W and T2W images. In this patient, diffuse low signal intensity is seen due to ineffective erythropoiesis causing a high level of iron deposited in the tissues. This characteristic signal intensity differentiates EMH from the other above-mentioned lesions. Since patients with thalassemia intermedia are almost never transfusion dependent, EMH is seen in a higher percentage of these patients. Hematogenic tissue is very radiosensitive, and masses usually regress with radiation and hypertransfusion, singly or combined. In this patient masses as well as patients’ symptoms responded well to radiotherapy.


Sohawon D, Lau KK,  Lau T, et al. Extra-medullary haematopoiesis: a pictorial review of its typical and atypical locations. 

25-year-old man presents with progressive lower extremity weakness.

Author | Sepideh Sefidbakht, MD

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Image IQ: 45-year-old Woman, Nonspecific Pelvic Pain and Fullness

Image IQ: 25-year-old, Progressive Lower Extremity Weakness