Multiple myeloma diagnosed after contrast-enhanced computed tomography without renal complications: a case report
Keiko Kudoh1, Takaharu Kudoh2, Yasuhiko Morita3
1Department of Oral Surgery, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-Cho, Tokushima, Japan.
Abstract:
In patients with multiple myeloma (MM), the use of contrast agents is generally contraindicated owing to the risk of acute renal failure. Despite precautionary statements in package inserts, guidelines note that the supporting evidence is limited. We report the case of a patient diagnosed with MM following contrast-enhanced computed tomography (CT) and discuss the clinical implications of contrast agent use. A 77-year-old woman presented with numbness of the right lower lip. Panoramic radiography revealed a radiolucent lesion with an unclear border in the right mandible. Contrast-enhanced CT, performed for suspected jaw carcinoma, demonstrated enhancing masses not only in the right mandible but also in the right skull, raising suspicion for MM. No adverse events were reported following contrast administration. A biopsy of the right mandibular lesion revealed plasma cell myeloma, and bone marrow aspiration confirmed symptomatic MM. Systemic chemotherapy resulted in tumor regression without renal dysfunction. Although renal failure occurs in approximately half the patients with MM, the risk of contrast-induced nephropathy is low in patients with normal creatinine levels, and contrast-enhanced CT does not appear to worsen renal function. When malignancy of the oral cavity is suspected, contrast-enhanced imaging may improve diagnostic accuracy. Further studies are needed to clarify the risk-benefit balance of contrast use in patients with MM without renal dysfunction, considering disease prevalence and the potential loss of diagnostic capability.
Insights
Contrast-enhanced CT may be safe for diagnosing multiple myeloma (MM) in patients with normal kidney function, despite general contraindications. This case study suggests contrast imaging can aid diagnosis without causing acute renal failure in MM patients.
Area of Science:
- Radiology
- Oncology
- Nephrology
Background:
- Contrast agents are generally contraindicated in multiple myeloma (MM) due to acute renal failure risk.
- Limited evidence supports the contraindication, despite package insert warnings and guidelines.
- Contrast-enhanced CT (CECT) is valuable for diagnosing head and neck malignancies.
Purpose of the Study:
- To report a case of MM diagnosed after CECT.
- To discuss the clinical implications of contrast agent use in MM patients.
- To evaluate the risk-benefit balance of CECT in MM.
Main Methods:
- A 77-year-old woman with suspected jaw carcinoma underwent CECT.
- Diagnostic imaging and subsequent biopsy confirmed symptomatic MM.
- Patient received systemic chemotherapy without renal complications.
Main Results:
- CECT revealed MM lesions in the mandible and skull.
- No adverse events or renal dysfunction occurred post-contrast administration.
- Chemotherapy led to tumor regression and preserved renal function.
Conclusions:
- CECT may be safe and diagnostically beneficial in MM patients with normal renal function.
- The risk of contrast-induced nephropathy is low in patients with normal creatinine levels.
- Further research is needed to clarify the risk-benefit of contrast use in MM without renal dysfunction.
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