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Multiple myeloma

Case contributed by Dr Ian Bickle

Presentation

Lethargy, weight loss and sallow appearance.

Patient Data

Age: 75 years
Gender: Male
X-ray

Multiple lucent lesions of variable size throughout the skull giving a pepperpot appearance.

Lucent expansile lesion in both 9th ribs.  Lungs clear.

Lucent lesion in the distal left humeral diaphysis with scalloping of the cortex.

United fracture of the distal third of the right clavicle with an underlying lucent bone lesion indicating a pathological fracture.

Benign, sclerotic focus in the left femoral metaphysis.

Small lucent lesions in the right pubic symphysis, left inferior pubic ramus and left ilium. 

Degenerative change in both knees.

Case Discussion

Multiple lucent lesions at various sites in the skeleton, including a raindrop appearance to the skull.  The appearances are one of two causes - metastases or multiple myeloma.

In addition to this skeletal survey, laboratory investigations were undertaken and confirmed the diagnosis of multiple myeloma.

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