Hemophilic pseudotumor is an uncommon complication seen in approximately 1-2% of 
patients with severe hemophilia. Hemophilic pseudotumors are distinguished into 
two subdivisions based on location, proximal or distal. Plain x-rays and CT are 
useful in diagnosis, but MR imaging is the diagnostic test of choice because of 
its sensitivity to the various blood products. The choice of therapy depends on 
many parameters, such as the size of the tumor, the age of the patient, and the 
relation with underlying organs. In most cases of asymptomatic hemophilic 
pseudotumor, conservative treatment with administration of missing factor as 
well as immobilization is recommended. The authors describe a 13-year-old boy 
with severe hemophilia A, who presented with a tibial pseudotumor a few months 
after an injury. He was conservatively treated for a long period, with daily 
administration of recombinant factor VIII. His clinical condition improved 
shortly after therapy induction, but radiological improvement has been moderate. 
Case history, imaging findings, and therapeutic options are discussed.