A 67-year-old male presented with persistent abdominal discomfort 2 years post-splenectomy carried out for myelofibrosis, complicated by anemia and thrombocytopenia. He was transfusion dependent at the time of presentation. Physical examination revealed bilateral loin masses. Contrast-enhanced multidetector computed tomography of the abdomen (Figure 1) identified homogenous, hypodense, non-enhancing rind-like, soft tissue masses in the perinephric spaces. Needle biopsy (Figure 2) of the left perinephric lesion showed numerous infiltrates of hematopoietic cells, which confirmed the diagnosis of extramedullary hematopoiesis (EMH).