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 4th rib.
No other thoracic cage lesion.
In this case a medical history was identified for this non illness based film after enquiry with the patient.
If this was a de-novo lesion a differential for a lucent rib lesion should be followed. Infact 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 candidates advice/management skills.
'What would you do next' ? Tests if practical advice to help clinician.