History of multiple myeloma. Pre-autologous stem cell transplant evaluation. SKULL: Again seen are numerous punched-out lytic lesions in the calvarium consistent with multiple myeloma appearing similar to prior study.CERVICAL SPINE: There are equivocal lucent lesions involving cervical spine. Severe degenerative disc disease affects the lower cervical spine. Slight kyphosis of the cervical spine is also present. THORACIC SPINE: Bones appear slightly demineralized, but we see no focal lytic lesions.LUMBAR SPINE: Bones appear demineralized, but we see no focal lytic lesions. Severe degenerative disc disease affects L4-L5. Moderate facet joint osteoarthritis affects the lower lumbar spine.RIBS: Multiple subacute and chronic rib fractures bilaterally likely reflecting underlying multiple myeloma.PELVIS: There is an angular deformity at the interface of S1/S2 vertebral bodies which may reflect a chronic fracture. We see no focal/discrete lytic lesions.UPPER EXTREMITY: Small poorly defined lucencies in the proximal humeral diaphysis bilaterally which may represent multiple myeloma. Poorly defined lucencies in the radius and ulna bilaterally may reflect multiple myeloma but is equivocal.LOWER EXTREMITY: Small lucency in the mid right femoral diaphysis likely represents myelomatous deposit. Soft tissue opacity seen on lateral view of the distal right femur along the anterior and posterior margins is suspicious for a juxtafemoral soft tissue mass, which may be further evaluated with MRI if clinically warranted. Poorly defined lucencies in the neck and diaphysis of the left femur likely represent multiple myeloma. Poorly defined lucencies in the right fibular diaphysis likely represent myelomatous deposits.
Multiple myeloma as described above appearing similar to the relatively limited outside study accounting for differences in technique. However, there is mild angular deformity of the upper sacrum that is new compared to the prior study and suspicious for a subacute fracture, as well as new soft tissue opacity along the distal right femur concerning for a soft tissue mass which can be further evaluated with MRI if clinically warranted.