Figure 1. The thoracic spine radiograph from the skeletal survey shows a paraspinal mass (arrow) on the right at T11-12 with loss of the right lateral cortex of the T11 vertebral body.

Figure 2. Contrast-enhanced CT of the chest, abdomen, and pelvis. (A) An infiltrate involves the superior segment of the left lower lobe of the lung. (B and C) There is an extension of the L4 lesion into the left psoas muscle. There are lytic lesions at (D) the C1 vertebral body (arrows) and the right 1st rib (arrowheads), (E) the medial left 10th rib (arrow), (F) the T11 vertebral body, and (G) the L5 vertebral body and the right ilium (arrow). (F) A lesion at T11 on the right contains faint, amorphous calcium centrally.

Figure 3. Lumbar spine MRI shows (A and B) multilevel vertebral body invovlement, with focal extension into the paraspinal musculature at the L3-4 level (arrow in B).