Clinical question: 79-year-old female with multiple myeloma, ESRD on HD. Transferred for septic shock. With exposed sacro- bones, evaluate for osteomyelitis. Signs and symptoms: Central decubitus stage IV ulcer. Fever Nonenhanced CT lumbar spine:Axial 3 mm CT images of the entire lumbosacral spine with zero degree angulation of the gantry were obtained.Sagittal and coronal 2-D reformatted images were also obtained for interpretation.Examination demonstrates multiple poorly defined lytic bony changes involving the vertebral bodies and posterior elements of lumbar spine consistent with patient's diagnosis of multiple myeloma. There is no significant interval change when compared with prior MRI examination from 3 -- 14 -- 11. The alignment the vertebral column is within normal limits. There is no detectable extraosseous spread of tumor into the spinal canal. Degenerative changes of SI joints bilaterally with vacuum phenomenon are noted.This examination demonstrates no evidence of findings to suggest osteomyelitis. The very tip of coccyx is not visualized on this exam.Note is made of very heavy calcification of abdominal aorta and bilateral iliac arteries.A large calcific mass in the midline in the pelvis is due to represent fibroid mass of the uterus.
1.No evidence of osteomyelitis on this exam as clinically is questioned. Recommend MRI if concern for osteomyelitis persists.2.Findings consistent with multiple myeloma with no appreciable change since prior exam from prior months.3.Mild degenerative disk disease and hypertrophic changes of posterior elements.4.Degenerative changes of the SI joints bilaterally with vacuum phenomenon.