Teenager with fever and left pleuritic chest pain

CXR and CT of Ewing sarcoma of the rib / Askin tumor
CXR PA and lateral (above) show a round mass on the lateral and middle aspect of the dome of the left hemidiaphragm. Axial CT with contrast of the chest (below) shows the soft tissue mass to be arising from a rib which has extensive and aggressive periosteal reaction.

The diagnosis was Ewing sarcoma of the rib (Askin tumor).