Multiple myeloma with peritoneal metastases

Atypical findings included peritoneal carcinomatosis, mediastinal adenopathy, pulmonary mass, hepatic mass and diffuse pelvic sclerosis by radiography.3 Other reports of extramedullary disease include bowel, nodal disease, solid organ disease, and isolated ascites.4-6 Metastatic bone survey is the initial test of choice, classically revealing well defined, punched out, lytic lesions. Findings on subsequent PET-CT studies can guide therapy, depending on the results of follow-up imaging.8 MRI has been shown to be superior to radiography in detecting lesions in the axial skeleton, but inferior in screening for long-bone lesions.9 Therefore, MRI is not an optimal screening tool, but still has clinical value in the management of patients where disease is clinically suspected, but radiographs are negative.