Images of Memorable Cases: Case 65 Chest radiograph of a 68-year-old man with a serum calcium of 13.5 mg/dL and a serum electrophoresis showing a monoclonal spike of 4.4 gm/dL. His physical examination, complete blood count, and urinalysis were normal. 65. Multiple myeloma Each of the large masses on the chest radiograph was contiguous with a partially destroyed rib (image below, arrowheads). Biopsies of one of the masses and of the bone marrow showed sheets of plasma cells. The masses, therefore, represented expanding plasmacytomas of ribs rather than pulmonary parenchymal lesions. Chest disease in multiple myeloma can manifest as infection or bone lesions, complicated at times by pleural effusion.