In osteomyelitis you see periosteal reaction and subperiosteal new bone formation. In Ewing's sarcoma you see multiple layers of subperiosteal new bone formation looking like onion peel. The mechanism is The lifted up periosteum generate new bone Tumor grows and partially replaces the bone leaving a thin line of bone behind The lifted up periosteum again form new bone The tumor replaces it again forming another line of subperiosteal bone This process continues and we get multiple layers of tumor:bone:tumor: bone like that
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C ray changes of EWINGS SARCOMA 1) primitive lytic lesion 2) bone sclerosis 3) onion peel or sun burst type periosteal reaction 4) codmans trangle 5) soft tissue calcification X ray changes in osteomylitis 1) regional osteopenia 2) periodteal reaction with pariostitis 3) focal bony lysis or cortical loss 4)Endosteal scalloping 5)loss of bony trabecular architecture 6) new bone apposition 7) eventual periosteal sclerosis
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