Images in Clinical Medicine
Lymphoma-Associated “Ivory Rib”
N Engl J Med 2003; 348:2423June 12, 2003
- Article
An 81-year-old woman was admitted with increasing generalized weakness, anorexia, and a weight loss of 7 kg (15 lb) over the previous three months. The only finding on physical examination was marked cachexia. Laboratory evaluation revealed anemia (hemoglobin level, 7.4 g per deciliter), leukocytosis (white-cell count, 15,400 per cubic millimeter), and thrombocytosis (platelet count, 450,000 per cubic millimeter). The chest radiograph showed a sclerotic 11th rib on the right side (Panel A, arrows). Subsequent bone scanning showed homogeneous uptake along the entire affected rib (Panel B, arrows). Bone marrow biopsy and rib biopsy led to a diagnosis of diffuse large-cell lymphoma. The patient chose palliative care and died shortly afterward.
The “ivory vertebra” has been well described in the medical literature in association with lymphoma, metastatic cancer, Paget's disease, sarcoidosis, Pott's disease, and primary bony tumors. Lymphoma-associated rib lesions are usually focal and not as diffuse as the lesion in this case of “ivory rib.”
Kenneth S. Stewart, D.O.
Donald L. Steinweg, M.D.
University of Virginia, Roanoke, VA 24033
