Answer of April 2004

Clinical History:

70-year-old lady with a recent onset of multiple painful sites, particularly severe over her left hip. Initial blood picture showed normochromic normocytic anemia with a hemoglobin level of 5 g/dL and an ESR of >100 mm/hr. Pelvic radiograph revealed marked generalized osteopenia with a left femoral neck fracture.

Diagnosis:

Multiple myeloma

Discussion:

This patient was suffering from an advanced stage of multiple myeloma with hypercalcemia and uremia. The bone scan illustrated a marked increase of tracer (methylene diphosphonate) uptake in many of the articular sites including both shoulders, elbows, wrists, hips, knees and ankles. The uptake was evident in the para-articular soft tissues in association with histology-proven amyloid deposition. There was also mild diffuse bilateral lung uptake that was likely related to microcalcifications or amyloidosis.