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How to distinguish Ewing's sarcoma from Chronic osteomyelitis?

Asked by Anonymous 

Significant predictors for diagnosis are:

A. Clinical: Ethnicity (African Americans are more likely to have osteomyelitis and in whites Ewing's was found to be twice as common as osteomyelitis)

B. Imaging: Soft tissue mass was predictive of Ewing's sarcoma

McCarville MB, Chen JY, Coleman JL, Li Y, Li X, Adderson EE, Neel MD, Gold RE, Kaufman RA. Distinguishing Osteomyelitis From Ewing Sarcoma on Radiography and MRI. AJR Am J Roentgenol. 2015 Sep;205(3):640-50; quiz 651. doi: 10.2214/AJR.15.14341. PMID: 26295653; PMCID: PMC5744678.

The presence of a bone lesion with a sharp and defined margin, optimally visualized on T1-weighted images in comparison to STIR images, is the most significant feature of Ewing sarcoma.

Henninger B, Glodny B, Rudisch A, Trieb T, Loizides A, Putzer D, Judmaier W, Schocke MF. Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging. Skeletal Radiol. 2013 Aug;42(8):1097-104. doi: 10.1007/s00256-013-1632-5. Epub 2013 May 19. PMID: 23685708. 


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