Imaging patterns in elastofibroma dorsi

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Abstract

Introduction

Elastofibroma dorsi is a rare pseudotumor of the soft tissues. Its clinico-radiologic characteristics lead to a correct diagnosis.

Material and methods

We followed 43 patients with elastofibroma dorsi with a confirmed histological diagnosis or on the basis of typical imaging pattern (ultrasound, CT, MR) confirmed by evolution.

Results

Elastofibroma is prevalent in females, its onset occurs around 60 years of age and is most frequently localized in the deep subscapular region (93%), bilateral in 54% of cases. In 7% it was found in an atypical isolated suprascapular region, in 7% it was synchronous to that in the subscapular region. Four ultrasound patterns were detected: Type I (54%) inhomogeneous fasciculated, Type II (22%) inhomogeneous aspecific, Type III (15%) hyperechogeneous, Type IV (9%) hypoechogeneous. Three patterns were detected at CT and MR: Type A (84%) inhomogeneous fasciculated corresponding to Types I and III and partially to Type II ultrasound pattern, Type B (8%) inhomogeneous aspecific corresponding to Type II ultrasound pattern; Type C (8%) homogeneous isodense or isointense to the muscle corresponding to Type IV ultrasound pattern.

Conclusion

A solid, slow-growing lesion, in the deep periscapular region in females aged between 50 and 60 years, with a typical fasciculated pattern is pathognomonic of elastofibroma dorsi and bilateral location convalidates diagnosis. Ultrasound is sufficient to orientate diagnosis. CT and/or MR are reserved only for non-fasciculated ultrasound patterns, when site is atypical or in candidates for surgery. Biopsy is reserved only in cases where integrated imaging shows a non-fasciculated pattern to differentiate it from other malignant lesions.

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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