PMC9124152_01
(a, b) A CT chest performed at the initial encounter. The CT chest obtained at the initial encounter revealed a large, heterogeneously enhancing mass occupying the majority of the right hemithorax with peripheral necrosis.
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A CT chest with contrast was performed (Figures 1(a) and 1(b)) which showed a very large heterogeneously enhancing mass occupying the majority of the right hemithorax with peripheral necrosis measuring approximately 16 x 14 x 11 cm (craniocaudal by anteroposterior by transverse dimensions).
A PET scan performed at the initial encounter. The PET scan obtained before starting treatment showed a large soft tissue mass occupying the right hemithorax, invading the anterior chest wall and the overlying ribs, consistent with the known Ewing sarcoma. There was no evidence of FDG-avid disease in the rest of the body.
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Based on the history, physical exam, and imaging results, the patient was admitted and a PET scan was performed (Figure 2).
This is the en bloc resected specimen showing the involved ribs completely resected (on the left side) with the residual Ewing sarcoma tumorous mass, including the thoracic muscles (on the right side of the picture), resected to secure free margins.
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Segmental lung resection had to be performed on the stuck right lower lobe, with pleurectomy as an en bloc with the whole specimen (Figure 3).