Multiple myeloma presenting as pleural mass

Abstract

A 61‑year‑old male presented with hemoptysis, low back pain, and significant weight loss for 2 months. He had never experienced any previous medical problems. He was fully conscious and oriented, emaciated, had grade two clubbing. His vitals were stable, and had dullness and reduced breath sounds over right supraclavicular and infraclavicular areas. He had normocytic normochromic anemia, very high erythrocyte sedimentation rate (ESR), and mild renal impairment. An upright posteroanterior (PA) view of chest radiograph showed homogenous opacity of right upper zone, clavicular fracture on right side, and bony erosions [Figure 1a], and computed tomographic scan with contrast of the chest showed 4.0 × 1.7 cm contrast‑enhancing soft tissue density peripherally in posterior pleural surface in right upper lobe apicoposterior region and heterogeneous bone densities in the ribs and vertebral bodies [Figure 1b‑d]. Our patient was diagnosed to have multiple myeloma (bone marrow aspiration showing 48% plasma cells, M band on serum protein electrophoresis, and lytic lesions on X‑ray skull and vertebra) with extramedullary dissemination to pleura presenting as pleural mass on biopsy. Extraosseous myelomarefers to a rare manifestation of multiple myeloma where there is plasma cell proliferation outside the skeletal and their presence has been associated with more aggressive disease. [1] Extramedullary involvement in multiple myeloma