Imaging patterns in elastofibroma dorsi
Introduction
Elastofibroma is a rare benign (pseudotumoral) hyperplastic fibroelastic lesion of the soft tissues localized mainly in the deep dorsal region, between the thoracic wall and the lower third of the scapula with a tendency to spontaneously stop its growth. Frequently it is bilateral and has a predilection for adult females after the 5th decade of life. Clinically it becomes evident, when it reaches a discrete size, generally over 5 cm, as a palpable mass firmly adherent to the deep region and mobile with respect to the superficial soft tissues. Painful at times it can delimit movement of the scapular girdle with a clicking sensation with anteposition of the scapula. Although seen rarely, it must be recognized to avoid diagnostic–therapeutic errors. Pathognomonic clinical and integrated imaging (ultrasound, CT and MR) findings consistent with elastofibroma point towards a correct diagnosis without the need of confirmation from biopsy.
Section snippets
Materials and methods
A retrospective study was carried out on 43 patients, 34 females and 9 males, average age of 60 years (range: 41–80 years), affected by elastoblastoma dorsi seen between 1988 and 2008 with the diagnosis confirmed by biopsy or on the basis of typical imaging features confirmed by the evolution during follow-up. In 41 patients (93%) location was typical, sited in the lower 3rd of the subscapular region, in six atypical where it was located in the suprascpular region, of these in three patients
Results
In all cases ultrasound identified oval lesions with ill-defined margins on both the superficial and deep planes. Color-Doppler never revealed intralesional vascularization and tranducer compression did not detect any morphologic variation whereas the lesions were always fixed to the deep costal plane and mobile to the superficial soft tissues. Four ultrasound patterns were identified of which Type I (inhomogeneous fasciculated) (Fig. 2) was the most frequent (54%), Type II (inhomogeneous
Discussion
Elastofibroma dorsi is a rare pseudotumor of the soft tissues with a predilection for females with a ratio of 4:1 F:M, its onset occurs at an average age of 60 years (range 41–80 years) in accordance with literature [1], [2]. The most frequent site was the deep dorsal region (93%) between the thoracic wall and the lower third of the scapula under the serratus anterior and the latissimus dorsi muscles [2]. In 14% of cases it was found located in the suprascapular region, isolated in 7% and
Conclusion
Elastofibroma dorsi, although rare, must be recognized to avoid diagnostic–therapeutic errors. The finding of a solid, slow-growing lesion, firmly adherent to the deep subscapular region in a patient between the 5th and 6th decade of life, with a typical fasciculated pattern is pathognomonic of elastofibroma dorsi, its bilateral location or its homolateral bifocality convalidate diagnosis. Ultrasound is the first examination and is sufficient to orientate diagnosis. CT and/or MR are reserved
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2015, Journal of OrthopaedicsCitation Excerpt :Use of radiotherapy in case of unresectable and disabling ED is controversed owing to their benignity.11 Prognosis of both resected and conservatively managed tumors, with single or multiple locations, is functionally favorable in addition to inexistent risk of malignant transformation.2,5 Elastofibromas are uncommon tumors generally evocative in elderly women.