Male 70 years old Reason: 70 yo male with multiple myeloma with worsening back pain History: worsening back pain BONE MARROW: Nonspecific scattered T1 hypointense foci in the osseous structures of the pelvis. Prior needle tract noted in the left ilium.SOFT TISSUES: Presacral soft tissue mass has decreased in size with a residual component of the presacral mass on the right of the rectum measuring 4.8 x 2.7 cm (image 20/series 1401) previously, 9.7 x 7.0 cm. The mass partially encircles the rectum.The reference left subcutaneous abdominal wall mass measures 6.0 x 3.7 cm (image 35/series 1501) previously, 4.6 x 3.3 cm.There are several lesions adjacent to the right psoas muscle with an infiltrative mass that extends into the right iliac fossa. The right psoas muscle is edematous. The mass partially encases the exiting nerve roots on the right.There are additional lesions in the bilateral gluteal muscles. The right pre-sacral lesion partially impresses upon the exiting right sciatic nerve.JOINTS: Mild degenerative changes affect the hips bilaterally. Moderate to severe degenerative changes affects the lower lumbar spine at L5-S1.ADDITIONAL
1.Decrease in the size of the presacral mass.2.Increase in the size of the left body wall mass.3.New areas of signal abnormality involving the gluteal, and right psoas muscle with new small enhancing lesions.