Additional pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com
Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
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:
Non-contributory
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.
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.
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.
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
References:
Additional pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com
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