A 43-year-old male from southern Iran, came in with chest pain and breathlessness of one month duration. He has had mild chronic anemia since childhood, however, he never received any blood transfusion. When he was 20, he developed fever and marked splenomegaly, and finally underwent splenectomy. The signs and symptoms associated with his chronic anemia persisted thereafter, until one month ago, when he developed chest pain and dyspnea on exertion. A chest roentgenogram was taken (above). A complete blood count revealed a Hb of 10.5 gr/dL with moderate to severe microcytic hypochromia, anisocytosis, poikilocytosis, and polychromatophilia. There were 5% reticulocytes, and total serum bilirubin was 2.5 mg/dL.
After receiving a total of 2000 cGy radiation, his complaint disappeared promptly. A chest X-ray, after one month, his paraspinal masses disappeared.
Your diagnosis?