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Ewing Sarcoma



Plain Films


Imaging of the primary site is essential to make the diagnosis and to start to establish the extent of the primary lesion:



Plain Films


First investigation to show abnormal-appearing bone



Lytic lesion of flat bone or diaphysis or metadiaphysis of tubular bone

  • Ill-defined, permeative bone destruction
  • Periosteal reaction - “onion-skin” type pattern is common
  • Periosteal reaction may have spiculated pattern



The extent of spread through the medullary cavity and adjacent soft tissues is usually greater than indicated on plain radiographs



The plain film below is of a primary ES involving the  femoral diaphysis.  There is an aggressive periosteal reaction (A points to this area).

A Codman triangle is sometimes seen with aggressive bone tumors such as ES.


The chest X-ray below shows a large right sided ES (#1) arising from a rib.




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