Left scapula lytic lesion - multiple myeloma

Case contributed by Chris Newman
Diagnosis certain


Chest wall pain

Patient Data

Age: 60 years
Gender: Male
  • 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.

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