Oncology · FDG · Intermediate

Paraprotein and low back pain in a 62-year-old

History

62-year-old man referred by haematology: IgG kappa paraprotein 34 g/L, 22% clonal plasma cells in the marrow, serum free light-chain ratio 38. Calcium, creatinine and haemoglobin normal. Mild low back pain; skeletal survey reported as normal. Question: smouldering or active myeloma?

Step 1 · The pelvic lesion

The right iliac focus is FDG-avid and the CT shows a 13 mm area of cortical and trabecular destruction. What does this mean?

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