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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 69 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 69

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Chief Complaint:
Seventeen year old male with chest pain.

Clinical History:
The patient was a 17 year old male who initially presented with fever, flu like symptoms and rib pain. Outside chest film at that time showed left lower lobe pneumonia, which was treated with antibiotics. Follow-up outside chest films showed a left pleural fluid collection and a questionable chest wall mass.

Clinical Physical Exam:
Palpable 5 x 5 cm left chest wall mass.

Clinical Labs:

Clinical Differential Diagnosis:
Askin tumor, osteosarcoma, osteomyelitis.

Imaging Findings:
Outside enhanced chest CT exam 2 months after the initial presentation showed a left chest wall mass with bony involvement. This was percutaneously biopsied and found to be a small round cell tumor with neurectodermal differentiation.

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Imaging Differential Diagnosis:
Askin Tumor

Operative Findings:
Two months after diagnosis the patient underwent a chest wall and diaphragm resection through an oblique incision over the seventh rib from posterior to the posteroaxillary line to the costal arch. He had partial seventh and eighth rib resections, en bloc wedge resection of the left upper lobe and left lower lobe and diaphragm. The diaphragm was repaired and a Gore-Tex patch was placed to close the chest wall.

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Pathological Findings:
Examination of the surgical specimen revealed findings characteristic for Askin Tumor - malignant small round cell tumor, consistent with primitive neuroectodermal tumor, 95% necrotic.

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Final Diagnosis:
Ewing Sarcoma, Chest Wall (Askin Tumor)

Follow-up and Prognosis:
The patient had some post operative fevers that were well handled with antibiotics.

Similar Cases:
Case 15, Case 18, Case 27, Case 46, Case 67, Case 68


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