Heart India

: 2014  |  Volume : 2  |  Issue : 2  |  Page : 54--55

A Forgotten Diagnostic Modality

Abdulhalim J Kinsara 
 Department of Adult cardiology, King Saud bin Abdulaziz University for Health Sciences, COM, King Abdul Aziz Medical City, King Faisal Cardiac Center, Jeddah, Saudi Arabia

Correspondence Address:
Abdulhalim J Kinsara
King Saud bin Abdulaziz University for Health Sciences, COM, King Abdul Aziz Medical City-WR, King Faisal Cardiac Center, P. O. Box 9515, Jeddah 21423
Saudi Arabia


Chest X-ray is a valuable modality that can point to the diagnosis in the appropriate clinical scenario. We are presenting a chest X-ray of a rare disease that can be spotted if the X-ray was critically analyzed. This simple test could fasten the appropriate management plan and save unnecessary referral.

How to cite this article:
Kinsara AJ. A Forgotten Diagnostic Modality.Heart India 2014;2:54-55

How to cite this URL:
Kinsara AJ. A Forgotten Diagnostic Modality. Heart India [serial online] 2014 [cited 2020 Sep 24 ];2:54-55
Available from: http://www.heartindia.net/text.asp?2014/2/2/54/134586

Full Text


Multiple myeloma of the lung is a rare site, however, can be picked up by regular chest X-ray. We are presenting a case with shortness of breath was caused by this disease and stress the importance of this simple test in revealing the diagnosis.

 Case Report

A 75-year-old man, known hypertensive admitted for bilateral knee replacement. His post-operative course was smooth and he went home after 10 days.

At 3 months later, he started to have progressive shortness of breath, to the extent that it interferes with his daily activity.

He was sent for cardiology evaluation with the presumptive diagnosis of pulmonary embolism versus heart failure.

On clinical examination, his vital signs and cardiovascular examination were normal. His lungs were clear.

Chest X-ray was requested [Figure 1].{Figure 1}

Did chest X-ray give you any diagnosis? What abnormality is noted?


The heart is enlarged. The lung fields are clear. Normal sized pulmonary vasculature. There is an elliptical soft-tissue shadow overlying the lateral aspect of the right 4 th rib the margins of which are ill-defined and probably destructed. The lesion is worrisome and is probably malignant in nature. His differential was multiple myeloma versus lymphoma.

Extra-medullary plasmacytoma accounts for about 3% of plasma cell malignancies and approximately 80% of which, in the oronasopharynx and paranasal sinuses, but association of multiple myeloma with lung plasmacytoma is found to be extremely rare. [1],[2]

The differential diagnoses of multiple myeloma are metastatic carcinoma, lymphoma, bone neoplasm and chronic lymphocytic leukemia. [3]

A biopsy from the lesion confirmed the diagnosis of multiple myeloma.

The case illustrates the importance of not narrowing the differential diagnosis, as multiple myeloma of the chest could have been diagnosed before referring to the cardiology.

In addition, it illustrates the usefulness of the chest X-ray, an investigation that becomes underused or not critically valued.


1O'Sullivan P, Müller NL. Pulmonary and nodal multiple myeloma mimicking lymphoma. Br J Radiol 2006;79:e25-7.
2Ramnik K, Duggal RK, Ramachandran KA. Multiple myeloma with extra-medullary dissemination in the lung. J Indian Acad Clin Med 2002;3:93-5.
3Kushwaha RA, Verma SK, Mehra S, Prasad R. Pulmonary and nodal multiple myeloma with a pleural effusion mimicking bronchogenic carcinoma. J Cancer Res Ther 2009;5:297-9.