Spontaneous sternal collapse in multiple myeloma

Pickard, Lucy; Whittaker, Charlotte; Jayakar, Vishal

doi:10.1111/bjh.13204

Cited by 6 publications

(2 citation statements)

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“…Spontaneous flail chest is rare in multiple myeloma[4-7]. The main interest of this case resides in restoring chest stabilization with the use of continuous positive pressure ventilation during a short period of time, without need to perform surgery and tracheostomy, while providing definitive chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Successfully non-surgical management of flail chest as first manifestation of multiple myeloma: A case report

Muñoz-Bermúdez¹,

Abella

Zuccarino

et al. 2019

WJCCM

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BACKGROUNDMultiple myeloma is a malignant neoplasm of the bone marrow characterized by neoplastic proliferation of monoclonal plasma cells with a high relationship with destructive bone disease. We present a case of a patient diagnosed with multiple myeloma and sternal fracture in association with multiple bilateral rib fractures and thoracic kyphosis, who developed a severe acute respiratory failure, thus complicating the initial presentation of multiple myeloma. We discuss the therapeutic implications of this uncommon presentation.CASE SUMMARYA 56-year-old man presented to Hematological Department after he had been experiencing worsening back pain over the last five months, with easy fatigability and progressive weight loss. He had no history of previous trauma. The chemical blood tests were compatible with a diagnosis of multiple myeloma. A radiographic bone survey of all major bones revealed, in addition to multiple bilateral rib fractures, a sternal fracture and compression fracture at T9, T10, T11 and L1 vertebrae. Subcutaneous fat biopsy was positive for amyloid. We started treatment with bortezomib and dexamethasone. After 24 h of treatment, he presented dyspnea secondary to flail chest. He required urgent intubation and ventilatory support being transferred to intensive care unit for further management. The patient remained connected to mechanical ventilation (positive pressure) as treatment which stabilized the thorax. A second cycle of bortezomib plus dexamethasone was started and analgesia was optimized. The condition of the patient improved, as evidenced by callus formation on successive computed tomography scans. The patient was taken off the ventilator one month later, and he was extubated successfully, being able to breathe unaided without paradoxical motion.CONCLUSIONThis case highlights the importance of combination between bortezomib and dexamethasone to induce remission of multiple myeloma and the initiation of positive airway pressure with mechanical ventilation to stabilize chest wall to solve the respiratory failure. This combined approach allowed to obtain a quick and complete resolution of the clinical situation.

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Section: Discussionmentioning

confidence: 99%

Successfully non-surgical management of flail chest as first manifestation of multiple myeloma: A case report

Muñoz-Bermúdez¹,

Abella

Zuccarino

et al. 2019

WJCCM

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“…This is probably due to the rarity of sternal fractures and scarcity of reports of long-term postoperative patient outcomes 14. Some authors have therefore chosen to accept sternal deformity 15. Available studies on sternal fractures are mainly performed on patients with trauma 14 16–18.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous sternal fracture due to multiple myeloma requiring extensive surgical repair

et al. 2015

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Spontaneous sternal fracture is a well-known complication of multiple myeloma due to osteolytic bone lesions. The possibility of a multiple myeloma should be thoroughly investigated in patients presenting with a spontaneous sternal fracture. This work up should go beyond protein electrophoresis alone as a monoclonal paraprotein is not always present. In some cases, the myeloma plasma cell clone produces only the free light chain (κ or λ) or may even be non-secretory. The underlying plasma cell dyscrasia is treated with chemotherapy and, if needed, local radiotherapy. However, for patients with a fracture causing persistent pain and physical discomfort, internal fixation may be additionally required. We present a case of a patient who presented with a displaced pathological sternal fracture. She was treated with chemotherapy, radiotherapy and an open reduction and internal fixation with a Locking Compression Plate (LCP). This technique offers a feasible option for rigid fixation of pathological fractures.

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