대한흉부영상의학회 Weekly Chest Cases

Case No : 638 Date 2010-01-18

Courtesy of Kwang Nam Jin / SMG-SNU Boramae Medical Center
Age/Sex 70 / M
Chief ComplaintChest Pain, Hb 11.8 g/dL

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Chest PA

Diagnosis With Brief Discussion

Diagnosis: Multiple myeloma
Radiologic Findings: Fig 1. Chest PA shows a pleural based mass like opacity at the left upper lateral hemithorax.
Fig 2. Rib AP image shows a fracture at the left 5th rib.
Fig 3. Noncontrast chest CT demonstrates an expansile osteolytic lesion at the left 5th rib and adjacent soft tissue thickening.
Fig 4. Rib AP image, obtained 6 months later, shows multiple osteolytic lesions in the bony thorax.
Brief Review: Most patients with multiple myeloma present with signs or symptoms related to the infiltration of plasma cells into the bone or other organs or to kidney damage from excess light chains. A normocytic, normochromic anemia is present in 73 % at diagnosis. Bone pain, particularly in the back or chest, and less often in the extremities, is present at the time of diagnosis in approximately 60 % of patients. The serum creatinine concentration is increased in almost one-half of patients at diagnosis in approximately 20 %. It is important to evaluate patients suspected of having MM in a timely fashion since a major delay in diagnosis has been associated with a negative impact on the disease course.

Multiple osteolytic lesions with discrete margins are typically detected radiologically in the vertebral column, ribs, or clavicles. Sclerosis generally develops in the osteolytic lesions after pathologic fracture, irradiation, or chemotherapy but occasionally can be seen also in untreated lesions. Pleural effusion and diffuse pulmonary involvement due to plasma cell infiltration are rare and usually occur in advanced disease.

The patients initially underwent chest PA and CT for the evaluation of chest pain. After 6 months later, multiple osteolytic lesions were found in the rib, spine and skull. CT guided biopsy for the pleural based lesion revealed that the lesion is multiple myeloma.
References: 1. Mayo Clin Proc 2003;78(1):21-33 Review of 1027 patients with newly diagnosed multiple myeloma.
2. RadioGraphics 2003; 23:1491
Keywords: Pleura, Rib, Malignant tumor,

No. of Applicants : 75

▶ Correct Answer : 13/75, 17.3%

- Montreal Chest Institute , Canada Faiz Khan
- PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- NTUH , Taiwan Kuei-pin Chung
- Institute of Chest Diseases,Calicut , India sijith raghavan
- Dong-A university hospital , Korea (South) Sang-yun LEE
- SMC , Korea (South) Jihoon Cha
- Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
- KMC,Manipal , India satish maddukuri
- Hospital M de Deus , Brazil Thiago Bento da Silva
- NASA SCANS , India RAKESH BHATIA
- kovai medical centre , India k bhaskar
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Mallinckrodt Institute of Radiology , United States Naganathan Mani

▶ Correct Answer as Differential Diagnosis : 11/75, 14.7%

- Service de pneumologie, Hitaux Universitaires de Gene , Switzerland GREGOIRE GEX
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- hospital de clinicas de porto alegre , Brazil ana zanardo
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- IRSA La Rochelle France , France Denis Chabassiere
- KKUH , Saudi Arabia Manar EL Essawy
- Homs National Hospital , Syria Rami Abou Zalaf
- Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
- Saga University , Japan Ryoko Egashira
- All India Institute of medical sciences , India Justin Moses
- Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 638 Date 2010-01-18

Discussion

No. of Applicants : 75