Myeloma with pathological fracture
Known myeloma with diffuse skeletal deposits. Worsening right leg pain, especially on weightbearing.
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Multiple lytic lesions with scalloping of the long bone cortices.
Periosteal reaction along the lateral aspect of the proximal tibia, with a smaller posteromedial component.
This supports the history and is consistent with a pathological fracture through a myelomatous deposit.
Disseminated lytic lesions should make you think of myeloma. If there is a history of pain, look carefully for evidence of fracture or a healing fracture as in this case.