Ewing’s Sarcoma
Presentation
A young man, 18 years old, is referred to your office by his family physician with a report of an abnormal chest x-ray finding. His chief complaint is progressively worsening weakness of the right hand and numbness of the right triceps muscle area. The patient reports that his right arm is heavy and that the shoulder is painful with exercise. He has fever and night sweats on occasion but no cough, chills, hemoptysis, or weight loss. He has been a one-pack-per-day smoker for the past 5 years. On examination, his vitals are stable except for a temperature of 100.5°F. There is fullness at the right base of the neck but no discrete mass. The breath sounds are decreased at the apex of the right lung field. The right scapular area is raised, and the right arm shows reproducible pain on abduction.
Recommendation
Computed tomography (CT) scans.
▪ CT Scans
 Figure 51-3 |
 Figure 51-4 |
CT Scan Report
The CT scans of the chest demonstrate a large, infiltrative, heterogeneous mass with multiple areas of necrosis arising from the right upper lung. It extends into the adjacent soft tissue of the right upper back between the ribs and the scapula. There is bony destruction of the right transverse processes of T1 and T2, the accompanying ribs, and possibly the scapula. The superior vena cava is distorted, but the arch vessels, although shifted to the left, are otherwise uninvolved. The tumor abuts but does not appear to invade the trachea.
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