Complete C4 vertebral body destruction: a dramatic finding in a patient with a new diagnosis of myeloma.

We report the case of a 60-year-old woman who presented to accident and emergency with left arm and neck pain. She had reported these symptoms to her general practitioner over the preceding weeks but no imaging was obtained. Radiographs revealed a pathological lesion in her left humerus. On review in the Orthopaedic Fracture Clinic radiographs of the cervical spine were obtained and showed complete destruction of the C4 vertebral body. She underwent corpectomy and stabilisation. Tissue diagnosis confirmed myeloma and she is now under the care of the haematologists receiving chemotherapy and radiotherapy. Myeloma is known to cause severe destructive lesions. Through the dramatic radiographic images this case serves as a reminder to clinicians to obtain imaging of patients with a new or existing diagnosis of malignancy, who show symptoms of skeletal pain, as lesions requiring emergency management may be present.