68Yrs old female history of IgG Lambda SII multiple myeloma; evaluate for lytic lesions and prep for clinical trial. SKULL: Two views of the skull show numerous lucent lesions, compatible with multiple myeloma, stable from prior exam accounting for positional differences.CERVICAL SPINE: Two views of the cervical spine are provided. Evaluation of the lower cervical spine is limited due to overlying anatomy. The bones appear demineralized, which may reflect diffuse myelomatous involvement. The C2 vertebra appears deformed, which may in part be artifactual related to positioning, however we cannot exclude the possibility of myelomatous involvement or prior trauma. This can be further evaluated with CT or MRI if clinically warranted.THORACIC SPINE: Single view of the thoracic spine is provided. Multiple compression fractures are redemonstrated, most severely affecting the T9 vertebral body. Loss of height of T7 appears to have progressed slightly when compared to the prior study. Severe compression deformities of T4 and T5 are additionally noted. LUMBAR SPINE: Two views of the lumbar spine are provided. The bones appear diffusely demineralized. Multiple compression deformities appear similar to the prior exam, with cement in the L4 vertebral body. Degenerative arthritic changes appear similar to the prior study.RIBS: Rib radiographs demonstrate multiple bilateral rib fractures, most of which appear to be healing or healed, though some are new when compared the prior study and are presumably related to underlying myelomatous deposits. Bone formation along the inferior margin of the scapula bilaterally may represent healing pathologic fractures. Right chest wall port catheter terminates in the right atrium. The lungs are underinflated. Streaky atelectasis is noted in the right mid lung zone.PELVIS: Single view of the pelvis is provided. The bones appear demineralized, perhaps representing widespread myelomatous deposition. Moderate osteoarthritis affects the right hip. Left hip hemiarthroplasty device appears similar to the prior exam. New heterotopic ossification about the lesser and greater trochanters is noted.UPPER EXTREMITY: Right humerus: Two views of the right humerus show small, poorly defined lucencies and endosteal scalloping appearing similar to the prior study, compatible with myelomatous deposits.Left humerus: Two views of the left humerus show small, poorly defined lucencies and endosteal scalloping appearing similar to the prior study, compatible with myelomatous deposits. Lucent lesion of the distal left clavicle also appears similar to the prior study.Right forearm: Single view of the right forearm demonstrates poorly defined lucencies in the radius which may represent myelomatous deposits, appearing similar to the prior exam.Left forearm: Single view of the left forearm demonstrates poorly defined lucencies in the radius which may represent myelomatous deposits, appearing similar to the prior exam.LOWER EXTREMITY: Right femur: Two views of the right femur demonstrate lucent lesions of the femoral diaphysis compatible with myeloma, appearing similar to the prior study. Moderate osteoarthritis affects the right knee.Left femur: Two views of the left femur demonstrate a bipolar hemiarthroplasty device situated in near anatomic alignment without evidence of hardware complication. Small lucent lesions in the distal left femoral diaphysis are consistent with myeloma, appearing similar to the prior study. Moderate osteoarthritis affects the left knee.Right tibia/fibula: Single view of the right tibia/fibula shows tiny poorly defined lucencies which may represent myelomatous deposits, appearing similar to the prior study.Left tibia/fibula: Single view of the left tibia/fibula shows tiny poorly defined lucencies which may represent myelomatous deposits, appearing similar to the prior study.
Findings compatible with widespread myeloma appearing similar to the prior study, with possible progression of thoracic vertebral compression fractures and rib fractures and possible healing scapular tip fractures.