Ewing sarcoma

120 views514y Female10/9/2026

Clinical Presentation

Right hip pain worsening over the last 6 months.

1The right iliac bone demonstrates an ill-defined lytic lesion, with a wide zone of transition
2The medial part of the acetabular cortex is poorly seen, potentially representing extension into the joint.In addition, there is some fullness and increased density of the soft tissues immediately medial to this region within the pelvis, suggesting extension beyond the bone
3There are smaller patchy translucencies of the right proximal femur, the inferior pubic ramus and the tuber ischii, as well
4Multiple intramedullary bone lesions involving both femora and the pelvis bilaterally
5Evidence of bilateral acetabular bone involvement with expansion and a soft-tissue component which is more pronounced on the right, extending both posterolateral to the bone (into the gluteus musculature) and medially (into the pelvis)
6Distribution of Ewing sarcoma
7Most frequent locations are the large long bones and the pelvis.Layout and distribution: Frank Gaillard 2009, Line drawing of skeleton: Patrick Lynch 2006, Creative Common NC-SA-BY Permeative and lytic lesion predominantly around the right acetabulum is demonstrated with multiple other lesions seen in the axial and appendicular skeleton
8CT reviewed on other window settings demonstrated no convincing solid organ metastases
9The flow and blood pool images of the pelvis show moderate increased tracer uptake involving both hip joint regions, more pronounced on the right side indicating evidence of hyperemia.On total body skeletal images, the skull shows multiple foci of heterogeneous and diffuse tracer uptake with a focal more intense uptake involving the left orbital ridge most likely metastatic in nature
10Further diffuse and heterogeneous uptake (likely metastatic deposits) in:multiple ribs on both sidesboth scapulaboth humeriright iliac boneboth acetabulum/ischiumleft iliac crestboth femoraMultiple vertebral bodies in the thoracolumbar region also show heterogeneous moderate tracer uptake worrisome for metastasis.