대한흉부영상의학회 Weekly Chest Cases

Case No : 1176 Date 2020-05-10

Courtesy of Park Hyejin, Choi Yo Won, Seung-Jin Yoo, Sang Hyun Paik / Hanyang University hospital
Age/Sex 33 / M
Chief ComplaintHeadache and impaired vision, left

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Diagnosis With Brief Discussion

Diagnosis: Extraosseous manifestation of multiple myeloma
Radiologic Findings: Figure 1. Initial chest AP shows subtle pleural nodularity in the both upper hemithorax.
Figure 2. Chest AP after 1 month shows bilateral pleural effusion with suspicious bilateral pleural nodularity.
Figure 3 -5. CT scans reveal multiple enhancing pleural nodules with bilateral pleural effusion and multiple homogeneously enhancing soft tissue masses at chest wall, paravertebral area, and retrosternal area.
Figure 6. Axial CT scan with lung window setting shows partial atelectasis at both lower lobes and no other abnormal finding in the lung parenchyma.
Figure 7. Coronal CT scan with bone window setting shows multifocal diffuse osteolytic lesions in the bony thorax.

In this case, multiple myeloma was diagnosed by bone marrow biopsy. Also, thoracocentesis was done and pleural myelomatous involvement was confirmed through pleural fluid cytology.

Figure 8. T1 enhanced brain MRIs show diffuse dural thickening with enhancement, extraosseous mass in the both orbit, and bone marrow signal change with enhancement in the skull.

Figure 9. T1WI and T1 enhancement with fat suppression of L-spine MRIs show diffuse low signal intensity of the bone marrow with multifocal enhancing bone lesions. Consistent with multiple myeloma.
Brief Review: Multiple myeloma is a malignancy of clonal plasma cell proliferation arising in the bone marrow. A minority of patients with multiple myeloma have imaging findings of extraosseous involvement. Recent studies suggest that clinically or radiologically detectable extraosseous manifestations occur in approximately 10
Please refer to
References: 1. Hall, Matthew N., et al. "Imaging of extraosseous myeloma: CT, PET/CT, and MRI features." American Journal of Roentgenology 195.5 (2010): 1057-1065.
2. Ormond Filho, Al
Keywords: pleura, chest wall, myeloma,

No. of Applicants : 83

▶ Correct Answer : 6/83, 7.2%

- Yeungnam University Medical Center , Korea (South) JONGSOO PARK
- Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
- National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
- , India SUSHANT JOSHI
- Private sector , Greece VASILIOS TZILAS
- the first affiliatited hospital of nanjing medical univercity , China HAI XU

▶ Correct Answer as Differential Diagnosis : 14/83, 16.9%

- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- , Japan SHIN-ICHI CHO
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Gifu University Hospital , Japan Yo Kaneko
- Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- , Japan SOTA MASUOKA
- Chonbuk National University Hospital , Korea (South) MINJEE KIM
- Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
- , Japan YUMI MAEHARA

▶ Semi-Correct Answer : 1/83, 1.2%

- Nishida Hospital , Japan SHOJI OKUDA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1176 Date 2020-05-10

Discussion

No. of Applicants : 83