The patient presented with a mass located at the inferior angle of the left scapula. The clinical examination showed a firm mass, which is visible only with abduction of the arm. Smaller mass is found on the other side.
This 55-year-old female presented with a painless mass, located at the inferior angle of the left scapula, discovered six months ago (Figure 1). On physical examination, the mass was located between the inferior angle of the scapula and the chest wall, only visible during abduction of the patients arm. It was firm, non tender, non movable, with ill-defines boundaries. There was a similar but smaller mass on the contralateral side. Plain radiography of the left scapula was normal. MRI of both scapular regions showed bilateral changes in the posterior chest wall, with poorly circumscribed, heterogeneous soft-tissue masses not clearly separated from the adjacent muscles. There was a weak enhancement after IV contrast injection. The left mass was larger and showed a tendency to a striated pattern (layers with signal intensity similar to skeletal muscle interlaced with strands of fat (Figures 2,3). The ultrasonographic examination showed the bilateral masses to be poorly circumscribed, with a typical appearance of hypoechoic and hyperechoic layers (Figure 4). There was no significant flow seen on power Doppler examination.
Elastofibroma dorsi is a rare, benign, slow-growing and asymptomatic pseudotumor, typically located at the inferior angle of the scapula, and predominantly seen in female (female-to-male ratio 5:1) (1). The mass is typically consisting in multiple layers with an alternating pattern of fibroelastic tissue and fat, arising between the extrinsic back muscles and the costal plane (2, 3). It is unclear wether this disorder is primary or results from repeated mechanical friction between the tip of the scapula and the chest wall (4), possibly related to Nordic walk. Bilaterality is generaly found (5). Many studies have reported that CT and MRI may show the typical multilayered appearance of elastofibromas (1, 4-6). More recently, the same typical multilayered structure was detected on ultrasonographic examinations (7). Hypoechoic strands correspond to fat entrapped between echogenic fibroelastic tissue (7). The association of characteristic location, typical multilayered appearance on diagnostic imaging, and the contralateral similar lesion virtually eliminates malignancy, and supports the diagnosis of elastofibroma dorsi without the need of biopsy or surgery (5).
Elastofibroma Dorsi
The patient is a 55-year-old female who reports a palpable mass in the area under the left scapular angle, which becomes more noticeable on arm abduction. Imaging (including MRI and ultrasound) reveals the following:
These imaging features align with the patient’s clinical symptoms, and there is no clear evidence of malignancy infiltration or bony destruction.
Based on the patient’s history and imaging characteristics, the following possible diagnoses or differential diagnoses should be considered:
Considering that the patient is a middle-aged female with bilateral, symmetrical lesions beneath the scapula, featuring a characteristic multilayer fibrous-fat distribution, and imaging findings that closely match clinical presentation, the most likely diagnosis is: Elastofibroma dorsi.
If the lesion grows rapidly or develops suspicious imaging features, it is recommended to perform a biopsy or follow-up imaging to exclude the rare possibility of malignancy.
Elastofibroma dorsi is usually a benign lesion. If it causes no serious symptoms or functional impairment, conservative treatment and periodic follow-up may suffice. Specific recommendations include:
During rehabilitation and in daily exercise routines, it is important to consider the patient’s cardiopulmonary and musculoskeletal conditions. Adhere to the FITT-VP principle (Frequency, Intensity, Time, Type, Volume, Progression):
If the patient has other comorbidities like osteoporosis or cardiovascular issues, exercise programs should be adjusted under professional guidance to ensure safety.
Disclaimer:
The above report is for reference only and is not a substitute for an in-person consultation or professional medical diagnosis and treatment. If you have questions or if symptoms worsen, please seek immediate medical care or professional advice.
Elastofibroma Dorsi
