Posted in Musculoskeletal on May 08, 2014 by m.khodeer
23 year old male, neck pain Findings? DDx?
Bone Scan Findings? Dose this narrow your DDx?
Pelvis Film Findings? Consistent with Previous studies?
Final images– “classic” Final Dx?
Answers
Multiple Myeloma
Initial neck radiograph showed 1 too many spinous processes; the corresponding vertebral body has collapsed = vertebra plana
General DDx for Vertebra plana: “MELT” Myeloma / Metastases; EG* / Ewings; Lymphoma / Leukemia; Trauma / TB
The cold lesion on bone scan is most consistent with myeloma, and this is borne out by the expansile pelvic lesion & lytic lesions shown
Myeloma Information
*Multiple Myeloma is the most common primary malignant neoplasm in adults; usually 5th to 8th decade, with 98% >40 year old
*Symptoms include bone pain, anemia, RBC roleau formation, renal insufficiency, hypercalcemia, proteinuria, monoclona gammopathy (see serum protein electrophoresis image above)
*Radiological findings – endosteal scalloping / “punched-out” lesions; expansile osteolytic lesions (ribs, pelvic); diffuse osteopenia (in 15%); sclerotic form (in 1-3%, associated with POEMS syndrome) *Primary DDx: Mets, Amyloidosis, Myeloid Metaplasia *Prognosis: 20% 5-year survival
Similar finding, Different patient
Above image show a more “classic” appearance for a vertebra plana
Alternative pnemonic: “FETISH” Fracture, EG, Tumor (myeloma, lymphoma, leukemia), Infection, Steroids, Hemangioma
Tags Multiple Myeloma
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