Radiological Findings In Multiple Myeloma

An 87 years old male came to radiology department for X-ray chest with history of bone pains, lethargy and cough.

The above X ray shows generalized reduction in bone density with wide spread destructive foci. The lesions are more prominent and larger in size in the left clavicle and proximal part of humerus. In
view of destructive bone lesions, patient was subjected to X-ray skull.

Chest X-ray shows prominent and large size destructive foci in the left clavicle and proximal part of humerus (arrows). X-ray skull (inset) shows multiple wide spread osteolytic rounded circular

defects of varying diameter from 2 mm to 15 mm with no surrounding bone reaction or sclerosis. The disseminated or generalized form of plasma cell infiltration of bone marrow is known as multiple myelomatosis. It is much more common for the widespread form to present radiologically as a fully developed entity over 40 years of age. 

Men are affected twice as common as women. Persistent bone pain or a pathological fracture is usually the first complaint.

Clinical Discussion: The two cardinal features in multiple myeloma are generalized reduction in bone
density and localize areas of radiolucency in red marrow areas. The axial skeleton, therefore, is affected predominantly. Lesions may be observed also in the shafts of long bones and in the skull. In spite of positive bone marrows aspiration, radiological feature may be absent in as many as one third of cases, at least at the initial presentation. This group of patients tends to develop generalized osteoporosis. Fifty percent cases present with proteinuria (Bence Jones proteinuria).

Radiology plays an important part in the initial diagnosis of the disease. A radiographic skeletal survey is superior to scintigraphic investigation using a bone-scanning agent, because the lesions are essentially osteolytic with no bone reaction. The distribution of lesions is extensive and destructive. The disease will not always be evident by the presence of the classic ‘raindrop’ lesions, circular defects of few mm to 2 or 3 cm in diameter.
Myelomatous lesions may erode the cortex and extend into the adjacent soft tissues. The resulting soft tissue masses are helpful in differentiating the advanced form of the disease from metastatic lesions. In chest, a destructive rib lesion with a large associated soft tissue mass is much more suggestive of myelomatosis than of a plasmacytoma