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case_images: Lumbar X-ray revealed multiple new vertebral body compression deformities involving T11, T12, L1, L2, L4, and L5.
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case_images: The lumbar spine X-ray (Figure 1) demonstrated osteopenia with multiple new vertebral compression deformities: T11-L1 with mild to moderate height loss, L2 with mild height loss, and L4/L5 with mild height loss.
case_images: Bilateral shoulder X-rays revealed innumerable osteolytic lesions (yellow arrow) involving the humerus, shoulder girdle bones, and left third rib.
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case_images: The shoulder X-rays (Figure 2) revealed diffuse, ill-defined lytic lesions throughout the shoulder girdle bones, highly suspicious for MM or possible metastasis.
case_images: MRI of the right shoulder, with and without contrast, revealed innumerable infiltrative marrow-replacing lesions (yellow arrow) throughout the shoulder. There was a full-thickness, full-width tear of the supraspinatus tendon, along with chronic strain at the myotendinous junction of the infraspinatus tendon. Additionally, an interstitial tear and tenosynovitis of the biceps tendon were identified. (A) Sagittal T1. (B) Sagittal T2 FS. (C) Axial T1 FS Post-contrast. (D) Axial T1 FS Pre-contrast.
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case_images: MRI of the shoulders (Figures 3 and 4) showed innumerable marrow-replacing lesions with left axillary lymphadenopathy, along with bilateral full-thickness supraspinatus tendon tears, moderate tendinosis of the left infraspinatus and subscapularis, and chronic strain of the right infraspinatus.
case_images: MRI of the left shoulder, with and without contrast, revealed innumerable infiltrative marrow-replacing lesions (yellow arrow) throughout the shoulder. Left axillary lymphadenopathy was also noted. There was a full-thickness tear of the anterior supraspinatus tendon in the setting of moderate tendinosis. Mild to moderate tendinosis of the infraspinatus and subscapularis was present. (A) Sagittal T1. (B) Sagittal T2 FS. (C) Axial T1 FS Post-contrast. (D) Axial T1 FS Pre-contrast.
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case_images: MRI of the shoulders (Figures 3 and 4) showed innumerable marrow-replacing lesions with left axillary lymphadenopathy, along with bilateral full-thickness supraspinatus tendon tears, moderate tendinosis of the left infraspinatus and subscapularis, and chronic strain of the right infraspinatus.
case_images: MRI of the lumbar spine, with and without contrast, revealed multiple chronic compression fractures throughout the lower thoracic and lumbar spine involving T11, T12, L1, L2, L4, and L5, resulting in 25%-50% height loss. No evidence of metastatic disease was found in the lumbar spine. (A) Sagittal T1 TSE. (B) Sagittal T2 TSE. (C) Sagittal T1 TSE Post-contrast. (D) Sagittal IR.
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case_images: MRI (Figure 5) demonstrated multiple chronic compression fractures involving the lower thoracic and lumbar spine with 25%-50% height loss, without retropulsion of bone toward the spinal canal. Mild degenerative changes were also noted, most pronounced at L4-5 and L5-S1.
case_images: Whole-Body CT myeloma workup revealed innumerable diffuse small lytic lesions (yellow arrow) throughout the axial and appendicular skeleton, which were highly concerning for multiple myeloma. (A) Bilateral pelvic girdle lesions. (B) Left femur and ilium lesions. (C) Right femur lesions. (D) Thoracic, lumbar spine, and sternum lesions. (E) Bilateral rib lesions. (F) Right scapular lesions.
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case_images: The WB-CT myeloma workup (Figure 6) revealed numerous small lytic lesions distributed throughout both the axial and appendicular skeleton, findings that were highly concerning for MM, with osseous metastasis considered less likely.