Student SYB Chet Cunha MS IV February 4, 2009

History 75 y/o M admitted for progressive weakness, inability to get out of bed. C/o R sided lower leg pain

Plain films Right leg

DDx lytic bone lesion Multiple myeloma Mets (breast, lung, kidney, thyroid) Eosinophilic granuloma (histiocytosis X) Brown tumor (hyperparathyroid) Benign bone lesions - endochondroma, chondroblastoma

Multiple Myeloma B lymphocyte defect Diffuse osteopenia Renal insufficiency Anemia Recurrent infection Can progress to amyloidosis

Multiple Myeloma Hypercalcemia Nongap acidosis Rouleaux formation Bence Jones proteins in urine Increased ESR

Multiple Myeloma Most common primary skeletal neoplasm Usually seen in vertebral column, ribs, skull, pelvis, and femora (axial skeleton) Typically multiple, discrete, small, lytic lesions Occasionally, seen as a single lytic lesion: plasmacytoma (solitary myeloma)

Multiple Myeloma Skeletal survey CT MRI

Further Reading Gourtsoyiannis, N.C., Ros, P.R. Radiologic-Pathologic Correlations from Head to Toe. Springer Publishing, Berlin Grossman, Z.D., Katz, D. S., et al. Cost-Effective Diagnostic Imaging. Mosby Elsevier, Philadelphia, 2006.

Thank you!