CTICasesMultiple Myeloma with Pulmonary Plasmacytoma Involvement
Imaging findings
CT demonstrates avidly enhancing subcutaneous nodules throughout the body and an unusual lung pattern characterized by peribronchial flame-shaped and linear densities with septal thickening, somewhat resembling Kaposi sarcoma or lymphangitic carcinomatosis. There is also a pericardial effusion. The lung findings have a peribronchial, peribronchovascular, and septal distribution. Biopsies of multiple lesions at different sites at different time points all confirmed anaplastic plasmacytoma from a high-grade aggressive multiple myeloma. The patient was not HIV positive.
Key takeaways
Pulmonary involvement by multiple myeloma or plasmacytoma can produce a peribronchial and lymphangitic pattern on CT resembling other lymphoproliferative diseases including Kaposi sarcoma and lymphangitic carcinomatosis. The avidly enhancing subcutaneous nodules are a clue to the systemic nature of the disease. Pulmonary plasmacytoma without mediastinal adenopathy is uncommon but can occur in aggressive or poorly differentiated myeloma. The CT pattern alone is non-specific, and tissue diagnosis is required for definitive identification.
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