Medical Imaging Analysis Report

I. Imaging Findings

The patient is a 72-year-old female with localized soft tissue masses found bilaterally in the scapular regions (below the scapula). MRI demonstrates masses within the soft tissue adjacent to the chest wall underneath the scapulae, closely related to the deep fascia or soft tissues. The signal characteristics are as follows:

• On T1-weighted and T2-weighted images, the primary lesion exhibits signal intensity similar to adjacent muscles, with multiple linear or patchy fat signal septations within the lesion.
• After contrast enhancement, it shows uneven mild-to-moderate enhancement, with mixed fibrous and adipose tissue signals.
• The borders are relatively indistinct, but there is no evident sign of invasion into surrounding bone.

Based on the imaging findings, the lesions are located deep to both scapulae, appearing elliptical or round in shape, potentially of firm or elastic consistency, and attached to the neighboring muscular or fascial structures.

II. Potential Diagnosis

Combining the clinical presentation (bilateral subscapular masses for several years, with mild clinical symptoms) and imaging characteristics (indistinct margins, muscle-like signal, and fat striations within), the possible diagnoses and differential diagnoses include:

1. Elastofibroma dorsi
   Commonly seen in older females, typically located near the inferior scapular margin on the chest wall. On MRI, it can appear with muscle-like signal interspersed with fat. Clinically, it often develops due to friction or high activity between the scapula and the thorax.
2. Desmoid tumor or other fibrous lesions
   These can also present with low-to-intermediate signal, though usually with more fibrous components, and may show different enhancement patterns. The typical location and lesion margins may differ somewhat from this case.
3. Liposarcoma
   May contain more adipose tissue, often demonstrating higher T1 signal. It is frequently more aggressive with unclear boundaries to surrounding structures; this case does not show obvious malignant features.
4. Neurofibroma
   May form a mass within soft tissue but is closely related to nerve pathways, often exhibiting characteristics of a nerve sheath tumor on imaging. This case has no clear changes in nerve bundle course.
5. Other rare soft tissue tumors
   For instance, malignant fibrous histiocytoma (now typically classified as undifferentiated pleomorphic sarcoma), although such lesions often demonstrate more pronounced local invasiveness.

III. Final Diagnosis

In summary, considering:

• Typical clinical scenario: an elderly female with slow-growing bilateral subscapular masses.
• Imaging findings: isointense to muscle, containing linear or patchy adipose signals, mild enhancement, indistinct borders yet without obvious invasion.
• Clinical symptoms: most patients experience no significant pain or only minor restrictions of shoulder movement.

The most likely diagnosis is Elastofibroma dorsi. If there is clinical uncertainty, a tissue biopsy can be performed to rule out other rare malignant conditions.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy
   • For patients with no significant symptoms or only mild shoulder discomfort, conservative management with observation and follow-up is often sufficient.
   • If the mass enlarges or causes marked pain or functional impairment, or if the diagnosis is in doubt, surgical resection may be considered. Complete local excision is generally performed, with a relatively low recurrence rate.
2. Rehabilitation/Exercise Prescription (FITT-VP Principle)

   During conservative management or post-surgery rehabilitation, a progressive exercise plan should be tailored according to the patient's age and range of motion:

   • F (Frequency): 3–5 sessions per week, adjusted gradually based on daily activity levels.
   • I (Intensity): Keep exercises within a range that avoids notable pain or fatigue. Begin with low-intensity shoulder joint active movements, such as flexion, abduction, and extension, possibly supplemented with resistance bands.
   • T (Time): 20–30 minutes per session. Initially, shorter intervals of 5–10 minutes can be used and extended to a continuous 15–20 minutes as tolerance improves.
   • T (Type):
     • Targeted stretching and strengthening exercises for the scapular region and thoracodorsal musculature, such as scapular circles and elastic band stretches.
     • Incorporate general aerobic activities (e.g., walking or cycling) while avoiding prolonged high-load shoulder motions.
   • V (Volume): Adapt total exercise volume to the patient's endurance and progress, aiming for at least 90–150 minutes of low-to-moderate intensity activities per week.
   • P (Progression): Increase resistance or duration gradually every 2–4 weeks based on improvements in range of motion and muscle strength. Avoid sudden increases in intensity.

   Patients should monitor for any shoulder or chest/back pain or swelling during exercise and adjust intensity accordingly. Post-surgery patients should resume activities gradually under the guidance of a physician or professional rehabilitation therapist.

3. Safety Considerations
   • In cases of concurrent degenerative joint disease or cardiopulmonary dysfunction, individualized assessments should be performed prior to designing a training regimen.
   • Avoid frequent forceful stretches or excessive abduction to prevent injury to the shoulder tendons or other joint structures.