Presentation
Several months of back pain and weight loss.
Patient Data
Large mass in right hemithorax, taking up much of the right lung's space, pushing on the trachea and right main bronchus, and causing splaying of the ribs around it. Expansile destructive posterior 5th rib lesion.
Large right pleural effusion.
The right upper lobe is compressed by the mass. Substantial right lower lobe atelectasis.
Lytic, expansile lesion of the posterior arch of the 5th right rib, with an intrathoracic heterogeneous soft tissue component measuring 10.8 x 10.5 x 11.8 cm. The primary lesion is probably the rib lesion, as the rib is expanded (cf. eroded only) and there is amorphic osseous content extending from the rib into the soft tissue mass. The mass compresses the right lung and displaces the mediastinum to the left.
Large right pleural effusion.
Case Discussion
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.
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