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A 65-year-old male presen ts for further evaluation secondary to progressive dyspnea on exertion, orthopnea, and left upper quadran t abdomi nal pai n. Physical examination reveals massive splenomegaly and bilateral lower extremi ty edema. Laboratory workup shows hemoglobin of 9.3 g/dl, leukocyte count of 1 8, 500/JLL, and platelets of LJ58,000/JLL. Peripheral blood smear is shown below.
Chest x-ray was otained secondary to orthopnea and lower extremity edema and is shown below.
What is the most likely etiology of patient's complaints?
- Congestive heart failure
- Extramedullary hematopoiesis
- Pulmonary embolism
- Anemia
- Hyperviscosity
Medicine
B. Chest x-ray reveals enlarged globular cardiac silhouette with indistinct borders. This finding in the context of myelofibrosis is suggestive of involvement by extremedullary hematopoiesis. Pericardia! biopsy revealed histologic findings of extramedullary hematopoiesis, and he was treated with low-dose radiation therapy. Involvement by extramedullary hematopoiesis in cases of myelofi-brosis has been reported to affect any organ or organ system. Low-dose radiotherapy is considered the optimal palliative treatment for local foci of extremedullary hematopoiesis (Mayo Clin Proc. 2003;78(10):1223).
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