PMC4899550_01
59-year-old male with myeloma. Plain films of the chest and left humerus. The left scapula is almost entirely destroyed. Only a small amount of the acromion remains. The film of the left humerus demonstrates permeative bone loss throughout. A well-defined, punched-out lytic lesion is seen in relation to the midshaft of the left humerus.
gr1.jpg
PMC4899550_01_gr1.jpg
fig1
A chest x-ray performed on admission, along with plain films of his left humerus (Fig. 1), showed near absence of much of the left scapula.
59-year-old male with myeloma. Contrast-enhanced CT scan of the thorax. The left scapula was almost entirely missing. It was replaced by a large, homogeneous soft-tissue mass that was biopsied, confirming the diagnosis of myeloma.
gr2.jpg
PMC4899550_01_gr2.jpg
fig2
A CT scan of the thorax, abdomen, and pelvis confirmed the presence of widespread lytic bony lesions, with a large soft-tissue mass centered around the left scapula (Fig. 2).
Isotope bone scan. Planar whole-body images obtained three hours following administration of 500 MBq of Tc-99m methylene diphosphonate (MDP). The striking finding was that of marked increased uptake by the stomach. Initially, the possibility of "free pertechnetate" was raised; however, none of the other patients scanned on the same day had any similar findings, and there was no salivary or thyroid uptake. This was therefore genuine gastric uptake of MDP. There was also increased activity arising from the nasal mucosa, as well as low-grade uptake in the lung parenchyma. (Uptake in the right 5th and 9th ribs posteriorly was related to minimally displaced fractures.)
gr3.jpg
PMC4899550_01_gr3.jpg
fig3
There was also apparent increased uptake of tracer in the nasal mucosa, as well as low-grade uptake in the lung parenchyma (Fig. 3).