Which radiographic finding is characteristic of thalassemia major?

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Which radiographic finding is characteristic of thalassemia major?

Thalassemia major causes profound expansion of hematopoietic bone marrow due to chronic hemolysis, so the marrow grows into the skull bones and thins the outer table. This bone expansion creates vertical striations in the cranial bones that radiate like hair standing on end, giving a distinctive hair-on-end appearance on skull X‑rays. This skull pattern is a classic radiographic clue to severe marrow expansion seen in thalassemia major and is more characteristic than other skeletal changes. Other options reflect different conditions or less specific changes. For example, H-shaped vertebrae are more typical of sickle cell disease, saddle nose deformity points to other nasal-structural or granulomatous processes, and while an Erlenmeyer flask deformity can occur with marrow expansion, the hair-on-end skull finding remains the most characteristic radiographic sign for thalassemia major.

Thalassemia major causes profound expansion of hematopoietic bone marrow due to chronic hemolysis, so the marrow grows into the skull bones and thins the outer table. This bone expansion creates vertical striations in the cranial bones that radiate like hair standing on end, giving a distinctive hair-on-end appearance on skull X‑rays. This skull pattern is a classic radiographic clue to severe marrow expansion seen in thalassemia major and is more characteristic than other skeletal changes.

Other options reflect different conditions or less specific changes. For example, H-shaped vertebrae are more typical of sickle cell disease, saddle nose deformity points to other nasal-structural or granulomatous processes, and while an Erlenmeyer flask deformity can occur with marrow expansion, the hair-on-end skull finding remains the most characteristic radiographic sign for thalassemia major.

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