50 year-old female with multiple myeloma since 2007. On chemo. Fever of unknown origin on imipenem and vancomycin. Also new onset right upper quadrant pain. Evaluate for source of infection. CHEST:LUNGS AND PLEURA: Multifocal partially solid and ground glass nodular opacities are identified within both lungs. Some of these have a more solid appearance and some are more predominantly groundglass. These effect all lobes of the lung. The majority are in the periphery and are predominantly pleural-based. Small pleural effusion on the right.MEDIASTINUM AND HILA: Heart size normal. No mediastinal lymphadenopathy.CHEST WALL: Multiple lytic lesions are identified with adjacent soft tissue components. This includes a destructive lesion within the sternum with soft tissue component that extends posteriorly near the aortic arch. This soft tissue mass is central low attenuation which is likely due to necrosis. A lytic lesion with soft tissue component is identified in the anterior right fourth rib as well as the posterior right 10th rib. There is compressive atelectasis and consolidation adjacent to the lesion in the right 10th rib. There is right -sided axillary lymphadenopathy. The largest single node measures 1.4 x 1.3 cm (image 23/25 of series number 9).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter punctate hypodense lesions in the kidneys are too small to characterize but likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions within the thoracic and lumbar spine at the patient's known myeloma. These extend into the spinal canal and appear grossly to have decreased compared with the patient's MRI on 11/5/2008. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Large inguinal lymph nodes identified. The largest single lymph node measures 2.9 x 1.8 cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are lytic lesions identified within the sacrum and pelvis consistent with multiple myeloma. A large lesion within the right iliac wing has a soft tissue component which measures 3.3 by 2.8 cm. Some of the lesions in the sacrum enter into the spinal canal.
1. Mixed groundglass and solid nodules in both lungs are nonspecific in etiology. They may represent infection, possibly fungal, drug reaction or less likely metastatic lesions.2. Multifocal lytic lesions with soft tissue component in the chest, abdomen and pelvis due to the patient's multiple myeloma.