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Multiple Myeloma and secondary amyloidosis and history of sarcoidosis

Brown GSB - MedPix (2008)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Multiple Myeloma and secondary amyloidosis and history of sarcoidosis

History: 46 year-old woman with history of sarcoidosis, anemia, hypertension, and carpal tunnel syndrome with complaint of intermittent bilateral conjunctival inflammation and hemorrhage for one year. She was initially seen by opthalmology who diagnosed and treated her for conjunctivitis associated with bilateral lacrimal gland enlargement demonstrated on numerous CT studies of the orbits. She was diagnosed with sarcoidosis thirteen years prior via bronchoscopy and maintains that she has remained asymptomatic. She also has bilateral upper extremity paresthesias that are diffuse but most notable in the ulnar nerve distribution of both the right and left hands and she has been diagnosed with bilateral carpal tunnel syndrome in the past year. She presents with no other complaints and review of systems is negative for constitutional, cardiopulmonary, gastrointestinal, genitourinary, or musculoskeletal complaints. Her most recent head CT was obtained during evaluation of URI symptoms and pain over the right maxillary sinus, for which she was diagnosed with sinusitis.

Findings: Head CT: Bilateral Lacrimal gland enlargement with homogenous tissue attenuation. Multiple lucenies of the skull bilaterally, particularly posterior to the vertex ranging 5-9 mm in size. Diffuse soft tissue attenuation noted in right maxillary sinus consistent with sinusitis. Skeletal Survey: Left upper extremity-single round, punched-out appearing lucencies in the region of the radial tuberosity and proximal humerus; PA-chest-single, round, punched out appearing lucency in the lateral left clavicle; Skull-numerous, round, punched-out appearing lucencies over the parietal and frontal bones.

Ddx: Multiple Myeloma Osteolytic Metastatic Carcinoma Hyperparathyroidism

Dxhow: Lacrimal gland biopsy demonstrating diffuse amyloid deposition. Serology demonstrates monoclonal gammopathy. Bone marrow biopsy pending pathologic analysis.

Exam: Physical exam: notable only for bilateral conjunctivitis and conjunctival hemorrhage and swelling Lab: No abnormal findings

No MeSH data available.


5-9mm diameter lucencies posterior to the vertex
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MPX1318_synpic41395: 5-9mm diameter lucencies posterior to the vertex


Multiple Myeloma and secondary amyloidosis and history of sarcoidosis

Brown GSB - MedPix (2008)

5-9mm diameter lucencies posterior to the vertex
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1318&req=5

MPX1318_synpic41395: 5-9mm diameter lucencies posterior to the vertex

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Multiple Myeloma and secondary amyloidosis and history of sarcoidosis

History: 46 year-old woman with history of sarcoidosis, anemia, hypertension, and carpal tunnel syndrome with complaint of intermittent bilateral conjunctival inflammation and hemorrhage for one year. She was initially seen by opthalmology who diagnosed and treated her for conjunctivitis associated with bilateral lacrimal gland enlargement demonstrated on numerous CT studies of the orbits. She was diagnosed with sarcoidosis thirteen years prior via bronchoscopy and maintains that she has remained asymptomatic. She also has bilateral upper extremity paresthesias that are diffuse but most notable in the ulnar nerve distribution of both the right and left hands and she has been diagnosed with bilateral carpal tunnel syndrome in the past year. She presents with no other complaints and review of systems is negative for constitutional, cardiopulmonary, gastrointestinal, genitourinary, or musculoskeletal complaints. Her most recent head CT was obtained during evaluation of URI symptoms and pain over the right maxillary sinus, for which she was diagnosed with sinusitis.

Findings: Head CT: Bilateral Lacrimal gland enlargement with homogenous tissue attenuation. Multiple lucenies of the skull bilaterally, particularly posterior to the vertex ranging 5-9 mm in size. Diffuse soft tissue attenuation noted in right maxillary sinus consistent with sinusitis. Skeletal Survey: Left upper extremity-single round, punched-out appearing lucencies in the region of the radial tuberosity and proximal humerus; PA-chest-single, round, punched out appearing lucency in the lateral left clavicle; Skull-numerous, round, punched-out appearing lucencies over the parietal and frontal bones.

Ddx: Multiple Myeloma Osteolytic Metastatic Carcinoma Hyperparathyroidism

Dxhow: Lacrimal gland biopsy demonstrating diffuse amyloid deposition. Serology demonstrates monoclonal gammopathy. Bone marrow biopsy pending pathologic analysis.

Exam: Physical exam: notable only for bilateral conjunctivitis and conjunctival hemorrhage and swelling Lab: No abnormal findings

No MeSH data available.