1. Student SYB Chet Cunha MS IV February 4, 2009

2. History 75 y/o M admitted for progressive weakness, inability to get out of bed. C/o R sided lower leg pain

3. Plain films Right leg

8. DDx lytic bone lesion Multiple myeloma Mets (breast, lung, kidney, thyroid) Eosinophilic granuloma (histiocytosis X) Brown tumor (hyperparathyroid) Benign bone lesions - endochondroma, chondroblastoma

14. Multiple Myeloma B lymphocyte defect Diffuse osteopenia Renal insufficiency Anemia Recurrent infection Can progress to amyloidosis

15. Multiple Myeloma Hypercalcemia Nongap acidosis Rouleaux formation Bence Jones proteins in urine Increased ESR

16. Multiple Myeloma Most common primary skeletal neoplasm Usually seen in vertebral column, ribs, skull, pelvis, and femora (axial skeleton) Typically multiple, discrete, small, lytic lesions Occasionally, seen as a single lytic lesion: plasmacytoma (solitary myeloma)

17. Multiple Myeloma Skeletal survey CT MRI

18. Further Reading Gourtsoyiannis, N.C., Ros, P.R. Radiologic-Pathologic Correlations from Head to Toe. Springer Publishing, Berlin 2005. Grossman, Z.D., Katz, D. S., et al. Cost-Effective Diagnostic Imaging. Mosby Elsevier, Philadelphia, 2006.

19. Thank you!