Presentation
Chest wall pain
Patient Data
Age: 60 years
Gender: Male
From the case:
Left scapula lytic lesion - multiple myeloma
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- eccentric ill-defined lytic lesion at the left lateral scapula margin
- a few other possible lytic lesions eccentrically located within the right proximal humerus medullary cavity
- old left proximal humeral fixation and multiple old bilateral rib fractures noted. This may suggest other underlying osseous lesions and subsequent pathological fractures
- clear lungs
- normal cardiomediastinal contour
Case Discussion
Lytic lesion of the left lateral scapula.
This case illustrates the importance of the bones as part of your chest x-ray check areas, especially in the setting of pain.
This lesion on its own carries a differential. Given its ill-defined nature, it is probably on the aggressive end of the spectrum (e.g. metastases, myeloma, lymphoma, infection) in an adult. A primary lesion of bone is possible but less likely.
This patient went on to have further cross-sectional imaging, which demonstrated multifocal lytic lesions, predominantly throughout the axial skeleton. The imaging in combination with the patient's serum results concluded a diagnosis of multiple myeloma.