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Neuroradiology Case of the Week

Case 214

Salman S. Mirza, DO and Per-Lennart Westesson, MD, PhD, DDS

Clinical Presentation: A 61-year-old female for a facial CT to evaluate for sinusitis.

Radiological Findings: AP and lateral scout images obtained prior to facial CT demonstrate multiple lytic lesions of the skull.

Diagnosis:  Multiple myeloma

Discussion: Multiple myeloma is a tumor that originates from the bone marrow and is the most common primary malignant bone tumor.  Peak incidence is seen in the fifth and seventh decades of life with a male predominance. The skull, spine, ribs, and pelvis are commonly affected sites, although no bone is exempt from involvement.
     Multiple myeloma presents in a variety of radiographic patterns.  Usually in the spine there is no clearly visible lesion and diffuse osteoporosis is only  seen with compression fractures.  More commonly multiple lytic lesions scattered throughout the skeleton.  In the skull there are  “punched-out” areas of destruction of uniform size.
     Common complication of multiple myeloma is a pathologic fracture. In 15% of patients the development of amyloidisis has been reported. Treatment consists of  radiotherapy and systemic chemotherapy. 

References:

1. Greenspan, Adam; Orthopedic Imaging: A Practical Approach; Lippincott Williams & Wilkins; 2004; pp. 734, 737-738.