International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. We report a case of a 16-year-old female who presented at our department for one month history of pleuritic chest pain. The physical examination and the thoracic radiography results supported a pleural effusion. The results of the first thoracentesis and pleural biopsy were not conclusive, thus a second thoracentesis was attempted but did not withdraw any pleural fluid. A thoracoabdominal computed tomography (CT) scan was performed which found a large infraphrenic tumor suspecting an adrenal neuroblastoma. A CT guided biopsy was done and the histopathology study revealed a malignant proliferation made of medium sized round cells. The immunohistochemistry concluded to Ewing's sarcoma. The diagnosis of primitive adrenal gland neuroectodermal tumor was established and adjuvant chemotherapy was recommended. The patient passed away during her first chemotherapy session. IJCRI publishes Conclusion:The adrenal localization of Ewing's sarcoma is rare. A neuroblastoma is the first brought up diagnosis in such presentation but an extraskeletal neuroectodermal tumor is also possible.