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ANSWER for, “What’s The Diagnosis In This Child With Lower Extremity Pain?”

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1. Can you name the disorder?
The disorder shown in these images is EWING'S SARCOMA. Ewing’s Sarcoma is a tumor of the long bones. A long bone is any bone that’s longer than it is wide. During your pediatric board review and on the pediatric boards, look for questions associated with X-rays of the humerus, femur, tibia or fibula.
  • Unique to this bone tumor is the possibility of a SOFT TISSUE COMPONENT
  • Lesions are painful, so a description of “exercise intolerance” could be from an inability to run
  • Shortness of breath or “decreased exercise tolerance” may be due to LUNG METASTASES!
2. Can you name the classic findings shown in the images?
  • WHITE ARROW: The white arrow on the image points to ONION SKIN lesions. Look for what looks like a thin extra layer of bone fitting over the bone like a glove. You can also imagine the skin of an onion laying over the bone. If you see this finding on the board, you’re done! Pick Ewing’s Sarcoma and move on.
  • RED CIRCLE: The red circle shows a SUNBURST pattern.
  • BLUE CIRCLE: The blue circle shows an OSTEOLYTIC lesion.

Ewing's Sarcoma with classic findings of a SUNBURST PATTERN and an OSTEOLYTIC LESION

Ashish Goyal, M.D.

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