Ewing sarcoma - humerus

Case contributed by Dr Jeremy Jones

Presentation

Injury to left arm while playing football. Pain and reduced range of movement.

Patient Data

Age: 12
Gender: Male
Modality: X-ray

There is a mid-diaphyseal left humeral lesion which has a permeative appearance and lamellated periosteal reaction. Features are of an aggressive bone lesion.

Modality: X-ray

Zoomed image of an aggressive bone lesion. 

Modality: CT

The permeative aggressive bone lesion with periosteal reaction is demonstrated on the CT.

Modality: MRI

The medullary replacementbone oedema and periosteal reaction are all clearly demonstrated on the MRI. The lesion is mid diaphyseal.

Case Discussion

This is an aggressive bone lesion and in a young teen, a mid-diaphyseal lesion is likely to be Ewing sarcoma (which biopsy confirmed). The extent of disease is identified by the low signal on T1, not the high signal on T2 (since this includes oedema). It is important to report the size of the lesion, distance from physes, involvement of metaphysis, physis or epiphysis and comment on skip lesions. The whole bone must be imaged.

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Case Information

rID: 27379
Case created: 1st Feb 2014
Last edited: 4th Dec 2016
Inclusion in quiz mode: Included

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