CTICasesVertebral Body Ewing Sarcoma with Paravertebral Mass
Imaging findings
A young patient's chest radiograph shows a retrocardiac paravertebral abnormality lifting the paravertebral pleural interface, with the underlying vertebral body at that level showing asymmetric loss of height and lucency compared with the adjacent, normal-appearing vertebral bodies -- centered on the vertebral body itself rather than the disc space. MRI confirms a large destructive lesion centered in the vertebral body with mild impingement on the spinal canal.
Key takeaways
A paravertebral soft-tissue abnormality centered on a single vertebral body, rather than a disc space, argues against discitis-osteomyelitis and should prompt consideration of a primary bone malignancy; here, biopsy after corpectomy and spinal reconstruction confirmed Ewing sarcoma isolated to the vertebral body in a patient in her late twenties. On review of this same radiograph, an apparent side-to-side difference in lung lucency was ultimately attributed to a technical grid-cutoff/off-centering artifact rather than true asymmetric lung disease, since the attenuation difference extended into the adjacent soft tissues as well.
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