대한흉부영상의학회 Weekly Chest Cases

Case No : 513 Date 2007-08-27

Courtesy of Myeong Im Ahn, MD. / St. Vincent’s Hospital, The Catholic University of Korea, Korea.
Age/Sex 70 / F
Chief ComplaintDyspnea

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Diagnosis With Brief Discussion

Diagnosis: Elastofibroma Dorsi, bilateral
Radiologic Findings: Enhanced axial chest CT scans with coronal and sagittal reformatted images show bilateral spindle shaped soft tissue density mass intermingled with strands of fat in the inferior subscapular region of the both chest wall, between the ribs and serratus anterior and latissimus dorsi muscles.
Brief Review: Elastofibromas are benign soft tissue tumors characterized by accumulation of abnormal (degenerated) fibroelastic tissue and fat. These tumors are relatively common lesions with the reported prevalence on CT of 2% in the elderly population, and are frequently overlooked clinically and radiologically. Most (> 50%) elastofibromas are asymptomatic. The symptomatic cases can present with an enlarging soft-tissue mass as well as with shoulder pain, discomfort, “locking,” or “snapping.” Ten percents of patients have bilateral involvement, which may be asymmetric in size.
On CT, they appear as poorly circumscribed elongated soft tissue masses, similar in appearance & density to adjacent muscles, interspersed with areas of fat, typically located deep in the inferior subscapular region, between the ribs and serratus anterior, rhomboid major, and latissimus dorsi muscles.
On MRI, the lesions show 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.
Elastofibroma dorsi has been shown to have variable enhancement, which may reflect increased vascularity of the lesion. Although the lesions typically are heterogeneous in attenuation or intensity with streaky layers of soft tissue and fat components, some can be homogeneous, which may be related to larger tumor size.
The sonographic features of elastofibroma dorsi have been reported as layers of hypo echoic strands in an echogenic background.
Recent reports demonstrated moderate degrees of FDG uptake in elastofibroma dorsi on PET/CT.
References: 1. Naylor MF, Nascimento AG, Sherrick AD, McLeod RA. Elastofibroma dorsi: radiologic findings in 12 patients. AJR Am J Roentgenol. 1996;167:683-7.
2. Bianchi 5, Martinoli C, AbdelwahabIF, Gandolfo N, Derchi LE, Damiani S. Elastofibroma dorsi: sonographic findings. AJR Am J Roentgenol. 1997;169:1113-5.
3. Brandser EA, Goree JC, El-Khoury GY. Elastofibroma dorsi: prevalence in an elderly patient population as revealed by CT. AJR Am J Roentgenol. 1998;171:977-80.
4. Wasyliw CW, Caride VJ. Incidental detection of bilateral elastofibroma dorsi with F-18 FDG PET/CT. Clin Nucl Med. 2005;30:700-1.
Keywords: Chest wall, Benign tumor,

No. of Applicants : 48

▶ Correct Answer : 28/48, 58.3%

- Osaka University, Japan Osamu Honda
- Samsung Medical Center, Korea Tae Yeon Jeon
- Samsung Medical Center, Korea Dae Kun Oh
- Asan Medical Center, Korea Eun Jin Chae
- St. Mary's Hospital, The Catholic University of Korea, Korea Yun Ju Lee
- Sinsegye Rad Clinic, Daegu, Korea Kim Gi Beom
- Samsung medical center, Sungkyunkwan university, Korea Young A Bae
- Changi General Hospital, Singapore Angeline Poh
- Rio Kenbi Clinic, Japan Shigeki Misumi
- Soonchunhyang University Hospital, Chunan, Korea Sang Hyun Park
- CHU, Grenoble, France Anne-Line Moroni
- Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- Maimonides Medical Center; Brooklyn, N.Y., U.S.A. Naomi Twersky
- Kyunghee University Medical Center, Korea Su Youn Sim
- IRSA, La Rochelle, France Denis Chabassiere
- Dept. of Radiology, Seoul National University Hospital, Korea Kwang Nam Jin
- CHU Grenoble France Pierre Yves Savoye
- Saint-etienne, France Antoine Marie
- Yongsan Hospital, College of Medicine Chung-Ang University, Korea Jae Seung Seo
- Annecy hospital, France Gilles Genin
- Saga Medical School, Faculty of Medicine, Saga University, Korea Ryoko Egashira
- Lilavati Hospital, Mumbai, India Mahavir Swami
- Ultracare Coimbatore, India Debabrata Das
- IRSA La Rochelle, France Jean-Luc Bigot
- Trakya University School of Medicine, Turkey Mustafa Kemal Demir
- Jackson Memorial Hospital, Florida, USA N.B.S.Mani
- University of Colorado Health Sciences Center, USA Seth Kligerman
- CHU Grenoble, France Bing Fabrice

▶ Semi-Correct Answer : 2/48, 4.2%

- Armidale Radiology, Australia Saurabh Khandelwal
- Pittwater Radiology, Australia Julie Arora

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 513 Date 2007-08-27

Discussion

No. of Applicants : 48