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This is an 18-year-old who sadly has right

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shoulder pain and the main finding

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is a large heterogeneous mass that is

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emanating from the scapula.

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We can see the permeative pattern of bone

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destruction with replacement of the normal

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fatty marrow in the anterior portion of

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the scapular body in this location.

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The mass is then extending from the bone

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and occupying the supraspinous fossa.

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It has heterogeneous signal intensity

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with areas that are more fluid-like,

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likely central necrosis and other areas

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where the mass is slightly more

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intermediate to low signal intensity,

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which could also be related to the

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presence of blood products

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or fibrous components.

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In an 18-year-old who has a process

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starting from the marrow, extending through

1:01

the cortex with this permeative

1:03

pattern of destruction,

1:05

you see the little holes in the cortex,

1:08

we have to think of Ewing sarcoma,

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which turned out to be the diagnosis

1:13

in this patient.

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On T1-weighted images here on the

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oblique coronal sequence,

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you can see the shortening

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of T1 within the mass.

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That's due to the presence of blood

1:25

products within the lesion.

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Another important finding is the presence

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of perilesional soft tissue edema.

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So, we see how therre is increased signal intensity on

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the fluid sensitive sequence,

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surrounding the entire mass and causing this pattern

1:44

of aggressive features. So in summary,

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bone marrow-replacing process,

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permeative pattern of bone destruction,

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large soft tissue component entirely

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occupying the supraspinous fossa,

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infiltrating the supraspinous muscle.

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We can see the muscle right there.

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The mass is occupying the supraspinous fossa.

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In a patient who is young,

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always think small round blue cell tumors.

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Ewing sarcoma was the diagnosis

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in this patient.