Solution: The MRI images show severe signal drop out in both the liver and the spleen (but not the pancreas) on both the T1 and T2 weighted images. When both the liver and the spleen are involved, the diagnosis is likely to be secondary hemochromatosis related to multiple transfusions. Alternative underlying causes would include: Thalassemia, cirrhotic patients with portocaval shunts, and increased iron intake as the most likely. Primary hemochromatosis is associated with severe iron deposition in the liver primarily and is associated with end organ damage (i.e. hepatic fibrosis and cirrhosis and HCC, diabetes due to pancreas damage, and hyperpigmentation of the skin ("bronze diabetes")), while secondary hemachromatosis is generally not associated with end organ damage.