The patient presented with a history of right lower shoulder swelling which had increased gradually over the previous two years. Physical examination showed a mass of soft consistency without tenderness or muscle weakness.
The patient presented with a history of right lower shoulder swelling which had increased gradually over the previous two years.
Physical examination showed a mass of soft consistency without tenderness or muscle weakness.
CT and MRI were subsequently performed. CT imaging showed a heterogeneous large mass with irregular shape and margins, located in the posterior chest wall, mild enhancement after contrast material administration and no calcifications. MRI showed a large mass with fibrous content and partial fat suppression.
Surgical excision was perfomed and a soft, uncapsulated mass was found. On histological examination, the lesion was proved to be elastofibroma dorsi.
Elastofibroma is a benign tumour-like lesion of soft tissue which may develop as a reaction process to mechanical friction. The most common age of appearance is over 55 years with an incidence of 24% in women and 11% in men and with a male-female ratio of 1:2. The posterior chest wall and the inferior margin of the scapula are the most frequent locations. The lesion is bilateral in 15% of cases.
Diagnosis is usually made on the basis of CT or MR images. On CT images, elastofibroma appears as a heterogeneous, poorly defined lesion of soft tissue attenuation similar to muscle. On MR images, elastofibroma is usually disclosed as a well-defined lesion of intermediate-signal intensity with interlaced areas of fat-intensity signal on T1- and T2-weighted images.
Histology of elastofibroma shows enlarged irregular serrated elastic hypereosinophilic fibres, collagen, scattered fibroblasts and occasional lobules of adipose tissue.
With regard to the clinical picture, the lesion is usually asymptomatic and may remain clinically inapparent. Sometimes, however, clinical symptoms, such as snapping scapula or shoulder pain, may be present.
Elastofibroma should be considered in the differential diagnosis of tumours deeply located within the periscapular area.
Elastofibroma dorsi
The patient is a 49-year-old female. A soft tissue mass-like lesion is observed in the right subscapular region (posterior chest wall near the lower edge of the scapula). The main imaging findings are:
On clinical examination, there is no significant tenderness or muscle strength decrease, but the patient reports a gradually enlarging mass in the subscapular region.
Based on the patient’s middle-aged female background, the location of the mass (near the inferior margin of the scapula or the deep posterior chest wall), imaging characteristics, and histological findings, the following diagnoses are considered:
Taking into account the patient’s age, clinical symptoms (slow-growing mass without significant pain), distinctive imaging features (muscle-density interwoven with fat signals), and pathological findings (irregular elastic fibers, focal adipose components, and fibroblasts), the most likely final diagnosis is:
Elastofibroma
If there are any atypical clinical features, progressive enlargement of the lesion, or onset of pain, further immunohistochemical testing or follow-up might be required to rule out other rare tumors.
For a confirmed elastofibroma, two general treatment approaches are available: conservative management and surgical intervention:
Since the patient currently does not manifest significant functional impairment or persistent pain, a conservative approach and rehabilitation training could be adopted:
This report is based on the currently provided clinical and imaging information and is for reference only. It cannot replace an in-person consultation or professional medical advice. If there are any changes in condition or further questions, patients are advised to seek medical attention or consult a specialist.
Elastofibroma dorsi
