Last edited 01/2021 and last reviewed 01/2021

Radiology of a Ewing's tumour shows bone destruction with overlying onion-skin layers of periosteal bone formation

  • medulla is more affected than the cortex. The latter may show signs of periosteal elevation
  • typical multiple, confluent, lytic bone lesions giving rise to images described as “moth eaten” on standard films
  • subperiosteal growth may translate into two other classic images — Codman’s triangle and the “onion peel” — which, respectively, represent the displaced periosteum and the resulting proliferative reaction


  • Riggi N et al. Ewing’s Sarcoma. N Engl J Med 2021;384:154-64.DOI: 10.1056/NEJMra2028910