Myelomatous rib lesion
Stem cell treatment for multiple myeloma 5 years prior. CXR for work purposes.
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Expansile lucent 'bubbly' lesion in the posterior aspect of the left 5th rib.
No other thoracic cage lesion.
In this case, a medical history was identified for this non-illness based film after inquiry with the patient.
If this was a de-novo lesion a differential for a lucent rib lesion should be followed. In fact, a popular film for fellowship viva examinations.
1. one needs to spot it (bones important review area of CXR); tests observation
2. give a sensible description of the findings; test of candidates descriptive skills
3. give a sensible differential; several for a lucent rib lesion from benign to malignant
4. check the candidate's advice/management skills
'What would you do next'? Tests if practical advice is given to help the clinician.