Not those Ewings: Ewing sarcoma

Case presentation

A 9-year-old male presents with a 4-month history of right upper arm pain. Over the past 2 months, he and his parents have noted the development of swelling to the arm as well. The patient is active in sports, particularly baseball, and the pain started after he pitched a game. He was given ibuprofen with some relief of the pain, but over the past several weeks, this has not been helping. He has not had fever, numbness, weakness, rash, or other symptoms.

Physical examination reveals a well-appearing pleasant patient in no acute distress. His vital signs are unremarkable. He has a normal physical examination with the exception of his right upper arm, where there is swelling, and tenderness of the midshaft of the right humerus. While he has normal gross range of motion, he does complain of pain with movement of the arm. There is no erythema, warmth, or fluctuance. He is neurologically intact.

Imaging considerations