Which radiographic finding is classically associated with multiple myeloma?

• A. Punched-out lytic lesions
• B. Ground-glass fractures
• C. Palisading cortical thickening
• D. Sclerotic osteoblastic lesions

Answer: (A)

The main idea is that multiple myeloma causes bone destruction through uncontrolled osteoclast activity from malignant plasma cells, leading to osteolytic lesions without new bone formation. On radiographs, this shows up as punched-out lucent lesions—well-defined, round or oval areas of bone loss that often lack surrounding sclerosis. These lesions are classically seen in the skull but can be present in the spine, pelvis, ribs, and long bones, and they explain why patients may have bone pain or pathologic fractures.

Other patterns aren’t characteristic of myeloma. Ground-glass changes aren’t the typical radiographic appearance here, and palisading cortical thickening doesn’t fit this process. Sclerotic osteoblastic lesions, by contrast, are more indicative of conditions with increased bone formation such as prostate cancer metastases, not myeloma, which tends to be purely lytic or mixed but not predominantly sclerotic.