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Well, here's a patient who is being evaluated for severe

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neck pain. On the sagittal reconstructions

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of an axial CT scan,

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we see that there are multiple lesions in the spine.

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We have a compressed vertebra of C3.

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We have a lytic area along the

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posterior elements of T2.

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We have a vertebra plana that is a very

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thin vertebral body at T3.

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And we see that there are other lytic lesions

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identified even into the manubrium,

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where there appears to be a pathologic fracture.

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An additional compressed vertebra is seen here at the

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T5 level. And if we actually look more superiorly,

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we identify that there appears to be a portion of the

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clivus that's completely missing here as it

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has been eroded with a lytic process.

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So we have multiple bone lesions which are lytic

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in nature in an 60 year old individual.

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First and foremost,

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we would consider metastatic disease.

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Oh, look, there's even a lesion in the mandible.

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A couple of lesions in the mandible, even.

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So, diffuse lytic process affecting multiple bones in the

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spinal canal, the skull base, the manubrium, even the mandible.

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So differential diagnosis is metastatic disease versus

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multiple myeloma. This was multiple myeloma.

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Multiple myeloma affects the skull in a very high

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percentage of cases. And this clivus lesion,

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which is extending to the petrous apex,

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is pretty classic for a patient

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who has multiple myeloma.

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They may have lytic lesions throughout their calvarium

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in frontal, parietal, temporal bones.

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And here you see additional cases of lytic lesion in the

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cervical spine. As far as having vertebra plana,

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that is more in keeping with a patient who has multiple

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myeloma than is with metastatic disease, because these

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vertebral bodies are associated with such poor

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bone that they will flatten. In a child,

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when we have vertebra plana,

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we're more likely to suggest histiocytosis x. In a 60 year

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old with multiple lytic lesions in skull and cervical

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spine, multiple myelomas, the best diagnosis.