Thallassemia major: hand radiograph


  • An 18 years old girl
  • Thallassemia major with regular blood transfusion
  • Currently also had iron overload
Radiograph of left hand in PA view

Radiographic findings:

  • There are coarse trabeculations involving the metacarpals, phalanges and carpal bones
  • Expansion of these bones are also seen
  • The cortices are thinned, however no fracture is seen
  • No obvious deformity.
  • Normal joint spaces

Diagnosis: skeletal changes in thalassemia


  • The skeletal changes seen in thallasemia patients are due to marrow proliferation
  • Within the medulla, first there is thinning of the trabeculae followed by their coarsening and expansion
  • Thinning of cortical bone and resorption of cancellous bone resulting in a generalized loss of bone density and yellow-to-red bone marrow reconversion.
  • The changes being most marked in the metacarpals and phalanges, which become cylindrical or biconvex in shape.
  • Fractures may occur, although less commonly seen than expected from the degree of osteoporosis.
  • Well-defined erosions of the periosteal margin of the cortex of the metaphysis or diaphysis may be identified in severe cases.
  • Other bones commonly involved include the skull, the facial bones and the ribs.
Author: radhianahassan