Presentation
Malaise, back pain, weight loss.
Patient Data
The cardiomediastinal contour is unremarkable. No focal consolidation, lobar collapse or overt cardiac decompensation. Lucent, expansile lesion of the superior aspect of right scapula. Additionally, left L1 pedicle is not visualized (“winking-owl” sign).
Multiple lytic expansile lesions throughout the imaged skeleton including the right scapular lesion and several lesions within vertebrae, sacrum and ribs. There is some narrowing of the spinal canal at the level of L1 due to the right L1 vertebral body/left pedicle lesion. Subsequent MRI did not show any cord compression.
Case Discussion
Subtle skeletal findings on chest XR make for important review areas. The 'winking-owl' sign (absent pedicle sign) is denoted by the unilateral absence of a vertebral pedicle. Multiple myeloma is typically associated with numerous 'punched-out' lytic lesions of the skeleton, often with associated soft tissue masses.
CT guided bone biopsy demonstrated plasmacytoma/myeloma.
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