Presentation
Initial presentation of left shoulder and upper limb pain, progressively worsening over time. Referred by orthopedics for a routine cervical spine MRI to rule out cervical disc herniation.
Patient Data
Diffusely heterogenous bone marrow signal intensity with areas of mixed signal intensity on T1-weighted images throughout the covered cervical vertebral bodies, showing signal reversal on STIR.
A complimentary multi-sequential pelvic MRI revealed extensive bone marrow involvement similar to the findings on the cervical spine MRI with larger well-defined lesions in the iliac bones and sacrum.
Innumerable well circumscribed lytic lesions scattered throughout the calvarium, giving a characteristic raindrop skull.
Case Discussion
In retrospect, a previous left shoulder MRI (not shown) obtained a few months prior to the current presentation revealed a relatively large T1-hypointense osteolytic lesion within the proximal humeral shaft with signs of cortical breaching, similar to the lesions seen in the bony pelvis.
Imaging findings suggesting disseminated multiple myeloma. Patient was referred back to hematology/oncology for further assessment.