Presented to the pediatric ED with 3 months of back pain and weight loss, then 3 weeks of chest pain and intermittent difficulty breathing. Chest x-ray showed a right sided chest mass and large pleural effusion. Chest CT was done and a chest tube was placed for drainage of the effusion.
Had a needle biopsy from the right posterior thorax and bilateral bone marrow biopsies. Pleural fluid was sent for cytology. The pleural fluid was not diagnostic and bone marrow was normal but the tissue specimen from the biopsy showed translocation (11;22), diagnostic of Ewing sarcoma.