A radiograph shows multiple radiolucent lesions in the mandible of a patient presenting with bone pain, fatigue, and malaise. How would you describe the observed radiographic pattern?

Correct answer: A. Punched out

• A. CORRECT — 'Punched out' radiolucencies with sharply defined non-corticated borders are the classic radiographic finding of multiple myeloma. They result from monoclonal plasma cell proliferation producing focal osteolysis with no reactive bone.
• B. Multilocular — this describes a soap-bubble/honeycomb radiolucency (ameloblastoma, odontogenic keratocyst, central giant cell granuloma). The lesions here are discrete round/oval lucencies, not divided by septa.
• C. Ground glass — a hazy, uniform opaque pattern typical of fibrous dysplasia, not multiple discrete lucencies.
• D. Cotton wool — this pattern (mixed radiopaque/radiolucent, ill-defined) is characteristic of Paget's disease of bone, not the well-defined lucencies shown here.