Presentation
Pelvic pain and tiredness. Recent fall.
Patient Data
Endosteal scalloping of the proximal right femoral diaphysis. Mild DJD of the hips. No other bone lesions. Appearances suspicious for a malignant process, multiple myeloma versus lytic bone metastases.
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AP pelvis and lateral right hip and proximal femur.
Further anterior and posterior cortical foci of endosteal scalloping of the right femoral diaphysis, increases suspicion for myeloma.
No fractures.
Case Discussion
Multifocal endosteal scalloping in an elderly patient most likely represents multiple myeloma. Hematological investigations confirmed this with an IgA paraprotein 56g/L.
Myelomatous deposits can easily be missed if one is not careful when reviewing plain radiographs, especially if one is concentrating on excluding fractures.
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