대한흉부영상의학회 Weekly Chest Cases

Case No : 140 Date 2000-07-01

Courtesy of Ki-Nam Lee, MD. / Dong-A University Hospital, Pusan, Korea
Age/Sex 59 / M
Chief ComplaintPalpable chest wall mass for two months

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Diagnosis With Brief Discussion

Diagnosis: Elastofibroma dorsi
Radiologic Findings: Precontrast CT scan shows bilateral, asymmetric masses in the subscapular and infrascapular areas.
On contrast CT scan, periscapular masses are poorly circumscribed, lenticular form with tissue predominantly of muscle attenuation, interspersed with thin strands of fat.
Brief Review: Elastofibroma dorsi is a benign fibroelastic lesion of unknown cause, most commonly found in the sub- or infrascapular regions of the chest wall. Elastofibroma is not rare at autopsy, with lesions 3 cm or smaller.
Elastofibroma is several times more common in women than men, and seen in more than 55 years old. The lesions are periscapsular in 99% of reported cases, and are often bilateral.

Although the cause of this lesion is not clear, it has been considered as a pseudotumor, reactive in nature, and attributable to mechanical friction of the scapula against the ribs during heavy manual labor. It can be explained that elastofibroma is thought to be more common on the right side, presumably related to the side of the patients' dominant handedness, and more common in manual laborer.

Elastofibroma is usually slow growing and not transformed into malignancy.

On CT, elastofibroma is typically a poorly defined, inhomogeneous soft-tissue mass with attenuation similar to that of skeletal muscle, containing linear streaks of fat attenuation.

The differential diagnosis of these lesions includes neurofibroma, cicatrical fibroma, and malignant fibrous histiocytoma. Bilateral periscapsular involvement of muscle density mass interlaced with strands of fat is helpful in differentiating from malignancy. Awareness of this finding will help avoid unnecessary biopsy and surgery.
References: 1. Naylor MF, Nascimento AG, Sherrick AD, McLeod RA. Elastofibroma dorsi: radiologic findings in 12 patients. AJR 1996;167:683-687
2. Kransdorf MJ, Meis JM, Montgomery E. Elastofibroma: MR and CT appearance with radiologic-pathologic correlation, AJR 1992;159:575-579
3. Gould ES, Javors BR, Morrison J, Potter H. MR appearance of bilateral periscapular elastofibromas. J Comput Assist Tomogr 1987;13:701-703
4. Yu JS, Weis LD, Vaughan LM, Resnick D. MRI of elastofibroma dorsi. J Comput Assist Tomogr 1995;19:601-603
Keywords: Chest wall, Benign tumor,

No. of Applicants : 40

▶ Correct Answer : 10/40, 25.0%

- 怨듦렐
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- 諛깆
- 諛李쎈
- 理以
- Hospital General Universitario de Alicante, Spain Juan Arenas
- Matsuyama Red Cross Hospital,Matsuyama,Japan Shunya Sunami
- Seoul National University Hospital So Young Yoo

▶ Semi-Correct Answer : 12/40, 30.0%

- 媛理
- 嫄닿뎅
- 怨
- 蹂대蹂源
- 源
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- 沅寃쎌
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- 源
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- Asan Medical Center Jeong Hyun Lee
- Seoul National University Hospital Hyuck Jae Choi

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 140 Date 2000-07-01

Discussion

No. of Applicants : 40