Great opportunities

Great opportunities for the diagnosis of bronchopulmonary manifestations of multiple myeloma appear when using computed tomography (CT). CT scan of the thoracic cavity organs was performed in patients with MM in cases where traditional X-ray examination did not allow to establish an accurate diagnosis, as well as in contradictions between the clinical picture and the clinical picture. Hos major task of RT – clarify the nature and localization of the pathological process Skog, its extent and prevalence with osed- of bodies . In MM CT, considerable assistance was provided in the diagnosis of tumors emanating from the ribs that squeezed the lungs and, in traditional X-ray examinations, created the effect of a “lung tumor”. 7 such patients are registered. In a traditional X-ray examination, radiologists expressed the opinion that these patients have peripheral lung cancer. Knowing the peculiarities of the osteodestructive MM process, CT scan of the chest cavity was performed. QD has a higher resolution in contrast than conventional techniques, and makes it possible to clearly identify organic structures . During the CT in these patients were able to establish that “tumor” is destroyed tissue edges, it comes out of it and causes compression of adjacent areas and second portion of the lung tissue. Pe ripheral lung cancer was excluded.

As an example, here is a brief extract from the case history No 45019. Patient M., born 1953 It was observed in the hematology department of the Amur regional clinical hospital from 1998 to 2003. with a diagnosis of multiple myeloma, diffuse-focal form, synthesizing PIg G, stage IIIA. In 2003, the development of chronic renal failure was established. From 1998 to 2003 radiographs of the chest were determined characteristic of MM destruction of the ribs. In 2003, during a survey of the lungs on the right, in the area of ​​the 6th rib, a “formation” was detected, which was initially regarded by the radiologist as peripheral lung cancer. . When performing CT, it was found that the tumor comes from the 6th rib on the right. These data were subsequently confirmed by autopsy results. In the middle third of the 6th rib on the right, a 10 × 8 cm formation was found, which gave a shadow on the radiograph. Histological examination revealed a characteristic pattern of myeloma tumor.

CT scan has provided significant assistance in the diagnosis of pleural myelomatous lesions. According to the histological examination after autopsy, specific myeloma pleural infiltration was observed in 8 patients. In 6 of them, myelomatous lesion was suspected during CT. The pleura in these patients was thickened. In two cases revealed focal, in six cases diffuse infiltration.

As an example, here is a brief extract from the history of the disease No 392. Diagnosis Multiple myeloma, which synthesizes PiGG, was exposed in 2002. At the initial course, he received treatment according to the protocol M 2 -VBMCP, reached the plateau phase, which lasted until 2007. Supportive therapy was conducted under this protocol. In January 2007, the disease recurred: a marked pain syndrome reappeared in the chest cell and spine, multiple bone destruction on radiographs of the skull, ribs, pelvic bones, and spinal column. Treatment according to the PAD protocol. The clinical effect is not marked. Since June 2007, tumor screening of the left pleura is determined on CT scan of the chest cavity, which significantly increased in size by October 2007. During the histological study of the puncture biopsy material of the “tumor” of the pleura, plasma cells were found. Currently, the patient is undergoing radiation therapy to the area of ​​pleural lesion.

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