Myeloma with pathological fracture

Case contributed by Derek Smith
Diagnosis certain

Presentation

Known myeloma with diffuse skeletal deposits. Worsening right leg pain, especially on weightbearing.

Patient Data

Age: 80 years
Gender: Male

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.

Case Discussion

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.

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