title: Ewing sarcoma of the rib--initial symptoms and clinical features: tumor missed at the first visit in 21 of 26 patients.
abstract: OBJECTIVE
  Doctor's delay in diagnosing Ewing sarcoma is often long. We examined the initial symptoms of Ewing sarcoma of the rib to find characteristics that could help to shorten the delay in diagnosis and hopefully influence the prognosis.
  
  
  METHODS
  We examined the records from the first visit for symptoms related to Ewing sarcoma of the rib in 26 consecutive patients, all of whom were <30 years of age and had been diagnosed between 1981 and 2000. All patients had a minimum of 5 years follow-up.
  
  
  RESULTS
  A tumor was suspected at the first visit in only 5 of the 26 patients; pleurisy was the most common misdiagnosis. 23 patients complained of pain, localized or pleuritic, and 11 had a palpable mass. 15 of the 26 patients had chest radiographs taken at the first visit, but a tumor was suspected in only 4 cases. The most common radiographic finding was pleural effusion--diagnosed in 10 of the 15 patients. 23 patients were operated. It is noteworthy that in 6 patients no tumor was suspected before surgery. 12 patients died from the Ewing sarcoma. Median survival was 2.4 years. Doctor's delay was median 3.0 (0-10) months, but it exceeded 7 months in 4 patients. Patient's delay was 2.5 (0-10) months.
  
  
  CONCLUSIONS
  The most important clinical finding in Ewing sarcoma of the rib was a palpable mass and pleural effusion. Both findings are rare in this age group and should be thoroughly investigated.
authors.affiliation: Division of Orthopedics, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Widhe
authors.forename: Torulf
authors.initials: T
authors.lastname: Widhe
authors.forename: Henrik C F
authors.initials: HC
authors.lastname: Bauer
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D002648:Child; D003951:Diagnostic Errors; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010996:Pleural Effusion / Q000175:diagnosis; D010998:Pleurisy / Q000175:diagnosis; D011379:Prognosis; D011859:Radiography; D012272:Ribs / Q000000981:diagnostic imaging; D012512:Sarcoma, Ewing / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors