Refractory multiple myeloma, now status post left hip hemiarthroplasty and L4 kyphoplasty. SKULL: Two views of the skull show numerous lytic lesions of various sizes compatible with multiple myeloma.CERVICAL SPINE: Two views of the cervical spine are provided. Evaluation of the cervical spine is limited due to the inability to optimally position the patient. The lower cervical spine is not well seen on the lateral view due to overlying anatomy. The C2 vertebra/dens is likewise not well seen which we suspect is artifact of suboptimal positioning, but we cannot exclude possibility of myelomatous involvement. This can be further evaluated with MRI if clinically warranted. There is mild multilevel facet joint osteoarthritis.THORACIC SPINE: Single view of the thoracic spine shows multiple compression fractures with near complete loss of height of the T9 vertebral body. The bones appear demineralized.LUMBAR SPINE: Two views of the lumbar spine show multiple compression fractures with cement in L4. Moderate to severe facet joint osteoarthritis affects the lower lumbar spine. The bones appear demineralized.RIBS: Rib radiographs show multiple healing/healed fractures presumably due to underlying myelomatous lesions. Note is made of multiple splenic granulomas and surgical clips in the right upper quadrant.PELVIS: Single view of the pelvis shows small poorly defined lucencies in the obturator rings which may represent myelomatous deposits but this is equivocal. The bones appear demineralized.UPPER EXTREMITY: Right humerus: Two views of the right humerus show poorly defined lucencies in the humerus which may represent myelomatous deposits. The bones appear demineralized.Left humerus: Two views of the left humerus show poorly defined lucencies in the humerus and distal clavicle which likely represent myelomatous deposits. The bones appear demineralized.Right forearm: One view of the right forearm shows poorly defined lucencies which may represent myeloma. The bones appear demineralized.Left forearm: One view of the left forearm shows poorly defined lucencies which may represent myeloma. The bones appear demineralized.LOWER EXTREMITY: Right femur: Two views of the right femur show several small lucent lesions consistent with multiple myeloma in the diaphysis. Moderate osteoarthritis affects the hip and knee.Left femur: Two views of the left femur show hardware components of a left total hip arthroplasty situated in near anatomic alignment. Skin staples are noted in the lateral soft tissues. Small lucent lesions in the distal diaphysis are consistent with multiple myeloma. Moderate to severe osteoarthritis affects the knee.Right tibia/fibula: One view is provided. Tiny scattered lucencies may represent multiple myeloma but this is equivocal. The bones appear demineralized.Left tibia/fibula: One view is provided. Tiny scattered lucencies may represent multiple myeloma but this is equivocal. The bones appear demineralized.
Findings compatible with multiple myeloma as described above.