Not all that lyses is malignancy: Multifocal hemophilic pseudotumor in a 13-year-old with hemophilia A

Hemophilic pseudotumors (HPTs) are rare but serious complications of severe hemophilia, characterized by encapsulated hemorrhagic masses that can mimic neoplastic lesions. Although incidence has declined with modern prophylaxis, HPTs still occur, especially in patients with inadequate bleeding control. We present the case of a 13-year-old male with hemophilia A and multifocal pseudotumor formation in the distal femur and tibia. The diagnosis was supported by multimodal imaging, which revealed multiloculated, hemorrhagic lesions with cortical erosion. The patient underwent surgical resection with bone grafting and plate fixation, with no postoperative complications. This case highlights the diagnostic role of imaging and the radiological characteristics of HPTs, outlining a safe and effective surgical management approach. Awareness of this condition remains crucial in hemophilic patients presenting with expansile bone lesions that might resemble primary bone tumors or other cystic neoplasms.