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Age / Sex : 76 / F
Age/Sex: 76/F
C.C.: Mass on Lt scapular area (incidentally detected) - huge(10x9cm) soft mass, nontender, movable, no pain mass
1) What is your impression?
Courtesy : Joo-Hyuk Lee, MD., National Cancer Center
Diagnosis: elastofibroma dorsi
Discussion
Findings:
1. CT 1)2) About 7 x 3.3 cm size, a well defined mass in the left chest wall; the mass had a soft tissue density intermingled with hypodense linear densities.
2. MR 1)2) On T1-weighted axial and coronal images, relatively well defined mass located below the left anterior serratus muscle can be seen with a intermediate signal intensity and linear strands of high signal intensity. 4) On Gd-enhanced image, the mass shows heterogeneous enhancement. 3) On axial T2-weighted images, the mass has low to intermediate signal intensity. The linear central strands are similar to subcutaneous fat.
Differential Diagnosis:
1) elastofibroma dorsi, more likely. 2) mass with large amount of collagen such as desmoid or fibromatosis 3) soft tissue lesion containing hemosiderin such as giant cell tumors of tendon sheath
Diagnosis: Elastofibroma dorsi
Discussion:
1) introduction Elastofibroma dorsi (ED) is an unusual, benign soft tissue pseudotumoral lesion, characterized by the proliferation of fibrous and adipose tissue in the infrascapular region which most frequently affects elderly women.
2) location Elastofibroma dorsi is usually found as an oval soft tissue mass in the subscapular area, bordered by the subscapularis, rhomboid, latissimus dorsi and serratus anterior muscles 3) Image findings a. CT ED is a non-encapsulated mass, with variably-defined borders, and a lenticular form with its long axis in craniocaudal orientation. It shows an heterogeneous soft-tissue attenuation, mostly similar to the skeletal muscles, with linear interlaced low density streaks suggesting mature fat. b. MR A predominance of areas of intermediate signal on T1-weighted images and relatively low signal intensity (slightly higher than muscles) on T2-weighted images due to dense fibrous connective tissue can be seen mixing with linear strands which have a signal intensity similar to that of subcutaneous fat, due to the adipose interspersed elements
4) differential diagnosis The hallmark in differential diagnosis is the relative hypointensity on T2-weighted images of ED, so the differential diagnosis should be established with relatively acellular tumors or with large amounts of collagen such as desmoid and with soft tissue lesions containing hemosiderin such as giant cell tumors of tendon sheath 4) treatment Surgical removal is indicated in large masses of ED, when symptoms are present or for stetical reasons. Only a few cases of local recurrence have been reported after incomplete resection.
References:
1. Elastofibroma Dorsi: MR and CT findings Eur J Radiol. 1998 Jul;27(3) 264-7
2. 견갑부 탄성섬유종 대한 골관절 종양학회지 별책 제 12권 제 2호 2006년
3. Bilateral elastofibroma dorsi, two case reports Clin Imaging 1999 Jan- Feb;23(1):47-50
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