Palpable Neck Mass and Multiple Bone Lesions

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Abstract
Dr. Jeffrey P. Rudnick: The patient is a 45-year-old physicist who had experienced malaise and generalized bone pain for about two years. Two days prior to admission, the patient noted severe pain in the left elbow while putting on his coat. On routine physical examination one year ago, a nodule, measuring 1.5 cm, was felt in the left lobe of his thyroid. Roentgenograms of the chest and long bones were obtained. Discussion Dr. Joseph Hanelin: There is a large lesion in the mid-ulna with adjacent soft-tissue swelling (Fig 1). I do not see a fracture. The edges of the area of destruction are not sharp, at least proximally, and the bone is quite thinned and expanded. Was he febrile? Dr. Rudnick: He did not have a fever. Dr. Hanelin: This is a destructive lesion, and in someone this age, one would think in terms of malignancy. Multiple myeloma is a

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