Abdominal Extraosseous Lesions of Multiple Myeloma: Imaging Findings

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Abdominal Extraosseous Lesions of Multiple Myeloma: Imaging Findings Anto Sedlic, MD, Christina Chingkoe, MD, Kit W. Lee, MBBS, Vinnay A. Duddalwar, MBBS, Silvia D. Chang, MD Canadian Association of Radiologists Journal Volume 65, Issue 1, Pages 2-8 (February 2014) DOI: 10.1016/j.carj.2011.12.010 Copyright © 2014 Terms and Conditions

Figure 1 (A, B) Contrast-enhanced portal-venous phase transverse and coronal reformat computed tomography (CT) images in a 54-year-old woman, showing central vein compression (A) (arrow). The diffuse extent of hepatic involvement and hepatomegaly is best demonstrated on the coronal images. (C) Contrast-enhanced delayed-phase CT in the same patient, demonstrating persistent hypoattenuation of the lesions. (D) Transverse ultrasound image of the liver in the same patient, demonstrating multiple hypoechoic heterogeneous nodules throughout the liver. Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 2 Noncontrast computed tomography in a 62-year-old man, demonstrating 2 focal hypoattenuating lesions in the dome of the liver (arrows). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 3 (A) Contrast-enhanced transverse and coronal reformatted computed tomography images in a 75-year-old man with known multiple myeloma who presented with painless jaundice, showing a heterogeneously enhancing mass in the pancreatic head (arrow). (B) Biliary and pancreatic duct obstruction, with dilatation of the common bile duct (arrow) and pancreatic duct (short arrow). (C) Transverse abdominal ultrasound of the same patient, demonstrating a hypoechoic mass that involved the pancreatic head (arrow), with pancreatic duct dilatation (arrowhead). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 4 Contrast-enhanced transverse computed tomography image of a 53-year-old woman, demonstrating a heterogeneously enhancing mass in the tail of the pancreas (arrow). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 5 Contrast-enhanced computed tomography in a 67-year-old woman with known multiple myeloma who presented with an upper-gastrointestinal bleeding after gastric artery embolization, showing diffuse gastric infiltration with mural thickening. Hypoattenuating regions in the stomach and spleen are thought to represent infarctions (arrows). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 6 Contrast-enhanced computed tomography image of a 58-year-old man, demonstrating a large mesenteric mass (arrow) and extensive peritoneal deposits. Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 7 Contrast-enhanced computed tomography image of a 54-year-old woman with a large, irregular, enhancing mesenteric mass posterior to the gastric fundus (arrow). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 8 (A) Contrast-enhanced computed tomography images of a 53-year-old woman with a lobulated enhancing mesenteric mass (arrow) and peritoneal implant (arrowhead). (B) Slightly lower image, demonstrating ascites with peritoneal enhancement (arrow). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 9 Computed tomography contrast-enhanced image of a 50-year-old man, showing a well-circumscribed left adrenal mass (arrow). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 10 (A) A 56-year-old man with a right perirenal myelomatous mass (arrow). (B) Ultrasound image of the same patient, demonstrating hypoechoic mass abutting the upper pole of the right kidney (arrow). (C) Coronal T2 single-shot fast spin-echo magnetic resonance image, showing a heterogeneous mass, with hyperintense internal signal, without definite renal invasion (arrow). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 11 Contrast-enhanced computed tomography image of a 55-year-old man, with nodular enhancing myelomatous mass (arrow) that encased the celiac artery and aorta. Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 12 (A, B) Arterial-phase contrast-enhanced computed tomography image of a 59-year-old woman with a retroperitoneal mass (arrows), demonstrating hypervascular characteristics of arterial-phase enhancement compared with the portovenous phase (B). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 13 Contrast-enhanced computed tomography image through the pelvis of an 82-year-old man, demonstrating an enhancing soft-tissue mass within the right seminal vesicle (arrow). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 14 Contrast-enhanced computed tomography image of a 54-year-old woman with a large right pelvic mass (arrow), demonstrating heterogeneous enhancement. Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 15 Contrast-enhanced computed tomography image through the pelvis of a 29-year-old woman, showing a mass (arrow) that involves the left gluteus muscles and the left internal iliac chain. Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 16 (A) Contrast-enhanced computed tomography of a 82-year-old man, demonstrating a pancreatic myelomatous mass (arrow). (B) Near-complete radiologic resolution is demonstrated 3 months later, after 6 cycles of chemotherapy. Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions

Figure 17 (A) Contrast-enhanced computed tomography of a 59-year-old woman, demonstrating a myelomatous retroperitoneal mass (arrow) with decrease in size 5 months later after 6 cycles of chemotherapy (B) (arrow). Canadian Association of Radiologists Journal 2014 65, 2-8DOI: (10.1016/j.carj.2011.12.010) Copyright © 2014 Terms and Conditions