Patient History
18-year-old with myofascial pain
Findings
ROTATOR CUFF: Normal.
SUBACROMIAL/SUBDELTOID BURSA: Normal.
MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Large oval soft tissue mass involves primarily the supraspinatus and to a lesser extent the infraspinatus and subscapularis. The mass demonstrates marked heterogeneity and on some slices resembles a “bowl of fruit.” Blood products are noted. Infiltration of the adjacent skeleton.
BICEPS TENDON: Normal.
AC JOINT: Normal.
CORACOCLAVICULAR LIGAMENTS: Normal.
SUBACROMIAL ARCH/OUTLET: Normal.
SUBCORACOID ARCH: Normal.
GLENOHUMERAL JOINT: Normal.
GLENOID LABRUM: Normal.
BONES: Abnormal with diffuse infiltration of the scapula with evidence of bone destruction and cortical disruption. Findings compatible with an aggressive neoplastic process.
SUBCUTANEOUS SOFT TISSUES: Diffuse swelling.
AXILLA: Abnormal adenopathy increased in number but not necessarily size.
Impressions
Large soft tissue mass involving a flat bone or the scapula measuring 7.7 cm mediolateral, 4.86 cm craniocaudal, and 4 cm anteroposterior. Given the presence of bone destruction, lesion size, lesion hemorrhage, and heterogeneity in a child, favor the diagnosis of Ewing sarcoma.
