ACR Codes: 4.3
The radiographic appearance of multiple myeloma is best seen in the flat bones, such as the axial skeleton (skull pelvis,and vertebrae) and proximal extremities (femurs and humerus), where this malignancy appears as numerous, small sharply punched out lesions without surrounding sclerosis. In the vertebrae, it also may appear as diffuse osteopenia without focal lesions.
Reference(s): 1. Cotran RS, Kumar V, Collins T: Robbins Pathologic Basis of Disease, 6th ed., Philadelphia, W.B. Saunders Company, 1999, pp 664-67.
2. Fauci AS et al.: Harrison’s Principles of Internal Medicine, 14th ed., New York, Mcgraw-Hill, 1998, pp. 713-17.
3. Juhl: Paul and Juhl's Essentials of Radiologic Imaging, 7th ed., Lippincott Williams & Wilkins
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Disease Topic 4172 
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