This is case of a 74 year old woman who presented following a femur fracture. She was found to be significantly osteoporotic, and imaging of her femur demonstrated possible subtle lytic lesions. She subsequently underwent a complete skeletal survey, which includes imaging of the skull. Frontal and lateral radiographs of the skull are presented and demonstrate innnumerable small lytic lesions throughout the calvarium. No matrix is identified within these lesions. Although the differential diagnosis for solitary lytic lesions of the calvarium is quite long, this appearance of innumerable lytic lesions of the calvarium is typical of multiple myeloma. An additional less likely differential consideration would include lytic metastatic disease such as lung cancer. Multiple myeloma is a relatively common disease, much more so than primary bone tumors. The leading diagnostic considerations for lytic lesions in an adult patient over 40 years of age should always include multiple myeloma and metastatic disease. PF206
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