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Age / Sex : /
Age / Sex : 52/F
Chief complaint : bilateral lower scapular area protrusion (Rt: 6 years, Lt: 3 years)
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
* Send Application Answers to Ja-Young Choi, MD ([email protected])
Courtesy : Jin-Suck Suh, MD., Department of Radiology, Severance Hospital.
Diagnosis: elastofibroma dorsi
Discussion
Findings:
- Ill-defined heterogeneous mass (approximately 9.6x3.2x7.4cm) between the serratus anterior muscle and posterior rib - T1 low and T2 low SI (similar with surrrounding muscle) with interlaced high SI on T1WI - Mild heterogeneous enhancement
Differential Diagnosis:
neurofibroma, cicatrical fibroma, malignant fibrous histiocytoma
Diagnosis: Elastofibroma dorsi
Discussion:
Introduction
- benign fibroelastic lesion of unknown cause
- considered as a pseudotumor, reactive in nature (not neoplastic), and attributable to mechanical friction of the scapula against the ribs during heavy manual labor
- probably arises from periosteal fibroblasts with deranged elastic fibrillogenesis
- an occupational history of manual labor and weight lift
- most commonly found in the sub- or infrascapular regions of the chest wall
- periscapsular in 99% of reported cases, and are often bilateral (10-66%)
- several times more common in women than men
- develop in middle-aged and elderly persons
Site : between the chest wall and inferior scapular (most characteristic)
- synchronous infraolecranon lesions (16%)
- hand, foot, greater trochanter, ischial tuberosity, deltoid region, temporal bulbar conjunctiva, and cervical epidural space
CT - a poorly defined, inhomogeneous soft-tissue mass with attenuation similar to that of skeletal muscle, containing linear streaks of fat attenuation
MR - relatively low signal intensity (similar to muscle) on T1- and T2- weighted images.
- interlaced fat is seen as strands of high signal intensity within these hypointense lesions
- variable enhancement, which may reflect increased vascularity of the lesion
References:
- AJR 1992;159:575-579 - Cancer 1982;50:1794-1805
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