Presentation
Three-month history of knee pain and limp.
Patient Data
Ill-defined lesion affecting proximal tibial diaphysis and metaphysis. Physis and epiphysis are grossly normal. Central areas of lucency and peripheral sclerosis with a wide zone of transition. Aggressive periosteal reaction and Codman's triangle present.
Abnormal signal within proximal left tibia, extending across physis into epiphysis but sparing articular surface. Extra-osseous soft tissue component. No other lesion within the imaged bone including joints above and below.
Multiple bilateral pulmonary nodules, up to 3 cm, in keeping with pulmonary metastases.
Abnormal uptake in left tibia at the site of primary malignancy. Uptake at the right wrist relates to the IV cannula. No other abnormal uptake.
Case Discussion
This is a case of biopsy-proven Ewing sarcoma, following a relatively typical presentation. As the findings on plain film are typical of an aggressive lesion, it is important to recommend prompt discussion with oncology and referral for staging investigations.
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