Pleural extramedullary hematopoiesis- a case report

Extramedullary hematopoiesis(EMH) is a compensatory phenomenon for insufficient bone marrow to meet the circulatory needs. This may even involve rarer sites like adrenals, dura, bowel , pericardium and pleura. Pleural EMH presents only in adult age group. It is usually asymptomatic. Presentation in pediatric age group with a very massive hemorrhagic pleural effusion is a very rare phenomenon. In our case a 12 years old female child with breathlessness, loss of weight and apetite and one episode of hemoptysis with no history suggestive of any other chronic illness or trauma. Past history revealed a positive contact history with tuberculosis. Child was wasted, had pallor, was dyspnoeic, and features of right sided massive pleural effusion. Investigations ruled out tuberculosis, malignancy or other connective tissue disorders. Traumatic rupture of vessels and bleeding disorders were also ruled out. Pancreatitis and other abdominal causes of hemorrhagic effusion were ruled out. Finally proceeding on to pleural biopsy which showed features of pleural EMH. Bone marrow studies were done further which was reported as normal. EMH is usually associated with insufficient marrow. But in our case, EMH of pleura( which is a very rare site), has occurred inspite of marrow function being normal. Intercostal drainage was done and external beam irradiation was started and the child got better and was discharged.