Abstract
Clinically, Ewing sarcoma in the bone can look like osteomyelitis (both can cause fever, increased serum inflammatory markers, and bone pain) and on imaging tests (both may present with aggressive periosteal reaction, cortical destruction, and articular involvement). Indeed, up to 50% of subacute osteomyelitis cases in children are misdiagnosed as malignancies, according to reports. However, because therapy and result are fundamentally different, differentiating between these two entities promptly and accurately is crucial. The narrowing of the differential diagnosis is complicated by two additional factors. For starters, age does not assist restrict the differential diagnosis because primary bone tumours and osteomyelitis are more common in children and young people. Second, in rare circumstances, infection and tumour may coexist. As a result, a pain and swelling presentation's underlying diagnosis may be confusing.
Conventional radiology (CR), which permits examination of the biological behaviour of isolated bone lesions, is the foundation of the initial approach to disorders of the bones and joints. It usually shows the lesion's location, internal matrix, borders, and accompanying periosteal reaction in great detail. Magnetic resonance imaging (MRI), which has a significant negative predictive value for malignant bone tumours, is now used as the primary diagnostic work-up for bone pain, particularly in children. If the MRI results are inconclusive, projection radiography or, in the case of overlapping regions, computed tomography (CT) must be used.
The difficulty in identifying Ewing sarcoma from bone and soft-tissue infection was highlighted in this study. Given the similarity in age, anatomical location, and clinical symptoms of infections and malignancies, a thorough study is recommended. Because no single clinical, biochemical, or radiological sign or investigation can be relied on to diagnose Ewing sarcoma, practitioners should send such cases to an Ewing sarcoma multidisciplinary team even there is just a little suspicion of malignancies.

Key words: Magnetic Resonance Imaging, Ewing Sarcoma, Osteomyelitis, Radiograph Study