Reason: history of multiple myeloma, r/o lesions and plasmacytoma History: sciatica, groin pain Again seen is a lesion of the right sacrum involving the right sacral wing which extends to the level of the fourth sacral segment on the right appearing similar to the prior study. This also extends to the mid body of the sacrum at the level of S2. The mass results in narrowing of the right S1 neural foramen and likely abuts the S1, S2 and probably S3 nerve roots. The mass extends anteriorly along the right inferior margin of the L5 vertebral body and is inseparable from the right L5 nerve root. The bandlike nature of this lesion indicates a prior pathologic fracture appearing similar to the prior study. The signal intensity and enhancement of the mass appears similar to the prior study. Much of the lesion does not appear to enhance significantly which presumably related to treatment effects. There is minimal signal abnormality within S5 that is less pronounced than on the prior examination and could reflect treated myeloma. We see no additional lesions. There is signal abnormality within the medial aspect of the right iliac wing which is likely related to altered biomechanics and prior bone marrow biopsies, unchanged. Mild degenerative changes affect the left sacroiliac joint. Deformity of the pubic symphysis likely represents osteoarthritis due to altered biomechanics. There is edema within the soft tissues posteriorly which is nonspecific but is not necessarily of any current clinical significance. Degenerative disc disease and facet joint osteoarthritis affect the lower lumbar spine.
Sacral plasmacytoma appearing similar to the prior study and other findings as described above.