Ewing’s sarcoma of the rib in a child

A 9-year-old boy was admitted to the emergency department with sudden onset of dyspnea without history of trauma or clinical signs of infection. Clinical examination revealed a painless, asymmetric swelling of the left anterolateral thoracic wall. Chest CT demonstrated expansile, mixed lytic-sclerotic lesions of the 5th rib and the 7th thoracic vertebral body. A large soft tissue mass was seen in the left hemithorax resulting in mediastinal shift and an extrathoracic component was present (Fig. A). MRI showed a large enhancing thoracic soft tissue mass (Fig. B) and a pathological fracture of the 7th thoracic vertebral body. Chest radiograph after central venous line placement illustrates the large size of the mass (Fig. C)