대한흉부영상의학회 Weekly Chest Cases

Case No : 913 Date 2015-04-27

Courtesy of Bo Young Jeong, Jeung Sook Kim / Dongguk University Ilsan Hospital
Age/Sex 77 / F
Chief ComplaintPalpable mass in the right back (several years ago) Physical exam: soft mass, tenderness (+)

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Diagnosis With Brief Discussion

Diagnosis: Elastofibroma dorsi (bilateral)
Radiologic Findings: Initial chest PA (Fig 1) shows asymmetric infrascapular soft tissue density in the right chest wall.
Chest CT axial and coronal images (Fig 2, 3) show well-defined lenticular soft tissue density masses intermingled with fat strands in the subscapular areas of both chest walls between the ribs and serratus anterior muscles.
MR images (Fig 4-6) show heterogeneously iso- to high signal intensity masses on T1- and T2- weighted images with heterogeneous enhancement in both subscapular areas. No significant abnormal signal change was seen in the adjacent muscle or bone.
Brief Review: Elastofibroma dorsi is a benign fibroelastic lesion that is typically located in infrascapular areas between the ribs and serratus anterior, rhomboid major, and latissimus dorsi muscles. Unilateral masses have a slight right-sided predilection, but up to 60% of elastofibromas are bilateral. Elastofibroma dorsi is most frequently seen in older women, with a reported female predilection of 5~13:1.Mean age at diagnosis is 65-70 years. Most (>50%) elastofibromas dorsi are asymptomatic, but may cause mild to moderate pain. Symptomatic lesions are surgically excised and generally remain free of symptoms.
On CT, elastofibroma dorsi is typically a poorly defined, heterogeneous soft-tissue mass with attenuation similar to that of skeletal muscle, containing linear streaks of fat attenuation. However, it has also been reported to show homogeneous attenuation without visible internal foci of decreased attenuation.
On MRI, the lesion shows relatively low signal intensity (similar to muscle) on T1- and T2- weighted images. Internal fat within these hypointense lesions is seen as strands of T1 high signal intensity.
Therefore, on imaging, elastofibroma dorsi shows variable enhancement, reflecting the increased vascularity of the lesion.
References: 1. Naylor MF, Nascimento AG, Sherrick AD, McLeod RA. Elastofibroma dorsi: radiologic findings in 12 patients. AJR 1996;167:683-687.
2. Dinauer PA, Brixey CJ, Moncur JT, Fanburg-Smith JC, Murphey MD. Pathologic and MR Imaging Features of Benign Fibrous Soft-Tissue Tumors in Adults. RadioGraphics, 2007, 27;173-187.
3. Kransdorf MJ, Meis JM, Montgomery E. Elastofibroma: MR and CT appearance with radiologic-pathologic correlation, AJR 1992;159:575-579.
Keywords: Chest wall, Others,

No. of Applicants : 101

▶ Correct Answer : 91/101, 90.1%

- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- Avrasya Hospital , Turkey Murat Ulusoy
- Government Medical College, Nagpur, India , India Krishna Prasad Bellam
- DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
- Northern Yokohama Showa university , Japan Kota Watanabe
- Seoul National University Hospital , Korea (South) Hyoung-In Choi
- Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
- Seoul university hospital , Korea (South) Youngjin Ryu
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Seoul National University Hospital , Korea (South) Hyun-ju Lim
- Shiga University of Medical Science , Japan Akitoshi Inoue
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- �stanbul , Turkey Ayhan Yilmaz
- UZA , Belgium Eline De Smet
- Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
- University of British Columbia , Canada Amr Ajlan
- Dong-A University Hospital , Korea (South) Won Jin Choi
- SNUH , Korea (South) Eui Jin Hwang
- Asan Medical Center , Korea (South) Soyeoun Lim
- Kosin University Gospel Hospital , Korea (South) Hee Kang
- 怨듭 , Korea (South)
- Ajou University hospital , Korea (South) Hun Cho
- Scans world , India Philson Mukkada
- Ricerche Diagnostiche, Bari , Italy Vittorio Pansini
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Kizawa Memorial Hospital , Japan Yo Kaneko
- SQUH , Oman Saleh Baawain
- Wuhan Union Hospital , China Qiguang Cheng
- China Medical University , China zhang wei
- Chonnam national university hospital , Korea (South) Jong-hyeon Kim
- Kyoto University , Japan Akihiko Sakata
- Okinawa Kyodo Hospital , Japan Shoko Iraha
- Kilpauk medical college , India abirami mahadevan
- chp st martin , France Mariotte benoit
- University of Tsukuba Hospital , Japan Sodai Hoshiai
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- santosh hospital , India Pravin Mahadevappa
- Onomichi municipal hospital , Japan Hirofumi Mifune
- McGill University Health Center , Canada Alexandre Semionov
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- Chonnam national university hospital , Korea (South) Wongi Jeong
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Niigata City General Hospital , Japan Takao Kiguchi
- university of montreal , Canada Andrei Gorgos I
- Chonnam National University Hwasun Hospital , Korea (South) Yunhong Yoon
- Korea university , Korea (South) Kun Woo Kang
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Ondokuz Mayis University , Turkey Cetin Celenk
- Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
- CHRU Lille , France Julien Pagniez
- CHU Poitiers , France CHAN paul
- Hospital Universitario y Politecnico La Fe , Spain Carlos Munoz-Nunez
- GHICL , France manuel toledano
- All India Institute of Medical Sciences , India Jitesh Ahuja
- , Korea (South) YongSub Song
- Asan Medical Center , Korea (South) Hyung Jung Koo
- Myongji hospital , Korea (South) Ji Ye Lee
- 異⑸ , Korea (South) Yunhee Jang
- Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
- VHS medical center , Korea (South) Keuntak Roh
- Hanyang universitiy, radiology department , Korea (South) HyunGyu Lee
- IRSA La Rochelle , France Denis Chabassiere
- Fortis hospital , Mohali , India Shaleen Rana
- chungbuk national university hospital , Korea (South) soojung lee
- Niigata University , Japan Atsushi Uehara
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Gifu Central Hospital , Japan Haruo Watanabe
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
- Bupyong Serim Hospital , Korea (South) Hee Seok Choi
- CLCC Rennes , France nicolas gautier
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- NIMS, HYDERABAD , India ashish sarode
- Pusan national university hospital , Korea (South) Hie bum Suh
- Kizawa Memorial Hospital , Japan Shoji Okuda
- CHU POITIERS , France SZTARK Guillaume
- Okayama University Hospital , Japan Toshiyuki Komaki
- Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
- Seoul National University Hospital , Korea (South) Sunkyung Jeon
- Pusan national university hospital , Korea (South) Jin Joo Kim
- Pusan university yangsan hospital , Korea (South) Jeong JIN
- pusan national university hospital , Korea (South) kim jeongmyeong
- Pusan national university hospital , Korea (South) Minkyu Kwak
- 遺 , Korea (South) LEE YOU JIN
- CNUH , Korea (South) Noh Hoon
- PNUH , Korea (South) Seungbaek Hong
- Medicheck health care , Korea (South) Chae Lim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 913 Date 2015-04-27

Discussion

No. of Applicants : 101