A 12 yrs old female presented with pain and soft tissue swelling in right arm since last 2-3 months.
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Radiograph right arm AP projection showing linear continuous type of periosteal reaction on lateral aspect of proximal-mid humeral shaft with associated large soft tissue swelling.
Also seen is subtle osteopenia in humeral shaft s/o of diffuse marrow infiltration .
Ewing sarcoma is highly malignant bone tumor seen in first two decades of life.
Although "Onion Peel" type of periosteal reaction is hallmark of this tumor but this is seen only in 25-30% of cases. Diaphyseal involvement and associated large soft tissue swelling are characteristic feature. Systemic features can mimic osteomyelitis.