대한흉부영상의학회 Weekly Chest Cases

Case No : 721 Date 2011-08-22

Courtesy of Kwang Nam Jin, M.D. / SMG-SNU Boramae Medical Center
Age/Sex 60 / M
Chief ComplaintChest discomfort

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Figure 2

Figure 1.

Diagnosis With Brief Discussion

Diagnosis: Elastofibroma dorsi
Radiologic Findings: CT shows a lenticular soft tissue mass with skeletal muscle attenuation interspersed with strands of fat attenuation in the inferior aspect of the left scapula.
Brief Review: Elastofibromas dorsi are benign fibroelastic lesions, most commonly found in the periscapular region. The tumor had a reported prevalence of 2% in a study of patients over 60 years old who were undergoing chest CT for evaluation of the pulmonary parenchyma.
It is classically found in the infrascapular regions, deep to the serratus anterior and latissimus dorsi musculature. 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 and a mean age at diagnosis of 65-70 years.
At clinical examination, elastofibroma dorsi is often asymptomatic. In up to 50% of patients, however, elastofibroma dorsi may cause moderate pain and clicking, snapping, or clunking of the scapula with movement.
Occasionally, elastofibroma dorsi manifests with shoulder pain and is misdiagnosed clinically as a rotator cuff tendon tear or subacromial bursitis. Most patients in whom symptomatic masses are surgically excised remain free of symptoms. Recurrence has been reported to occur on rare occasions but is thought to be secondary to incomplete excision.
The CT appearance of elastofibroma dorsi is diagnostic. A poorly defined soft-tissue mass in the infrascapular or subscapular region with attenuation similar to that of the adjacent skeletal muscle is seen. These masses have been reported to have soft-tissue attenuation at CT with internal striations or scattered areas of fat attenuation. However, elastofibromas have also been reported to have homogeneous attenuation at CT without visible internal foci of decreased attenuation.
References: 1) Elastofibroma dorsi: radiologic findings in 12 patients. AJR:167, Sep, 1996
2) Pathologic and MR Imaging Features of Benign Fibrous Soft-Tissue Tumors in Adults, RadioGraphics, 2007, 27;173-187
3) Best Cases from the AFIP: Elastofibroma Dorsi RadioGraphics 2006, 26:1873-1876
Keywords: chest wall, benign tumor, neoplasm,

No. of Applicants : 78

▶ Correct Answer : 55/78, 70.5%

- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Hangang sacred heart hospital , Korea (South) You Mie Han
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Fr Mullers Medical College , India Deepu Thomas
- snuh , Korea (South) Choo jiyung
- Okayama University , Japan Akihiro Tada
- Inha University Hospital , Korea (South) Ju Won Lee
- Sunchun university hospital, Bucheon , Korea (South) So Young Bae
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Youngdong Hospital , Korea (South) Sang Min Lee
- Seoul National University Hospital , Korea (South) YongSub Song
- NZOZ Diagnostica s.c. Koszalin , Poland Krzysztof Owsianny
- Montreal , Canada D J
- IRSA La Rochelle France , France Denis Chabassiere
- All India Institute of medical sciences , India Justin Moses
- UZ GASTHUISBERG , Belgium Johan COOLEN
- KUMC ansan , Korea (South) kihwan kim
- chp st martin , France Mariotte benoit
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- Yonsei University College of Medicine Severance Hospital , Korea (South) GA RAM KIM
- Consultant Radiologist, London , United Kingdom Shekhar Banavali
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Cincinnati Childrens Hospital Medical Center , United States mantosh rattan
- Radiologie Brabois adultes , France ROPION helene
- McGill University Health Center , Canada Alexandre Semionov
- Seoul National University Hospital , Korea (South) Donghyn Kim
- Kobe City Medical Center General Hospital , Japan Junko Ochi
- Onomichi municipal hospital , Japan Ryotaro Kishi
- DCA, , India Rajesh Gothi
- Okayama university , Japan Mayu Uka
- Hotel-Dieu Montreal , Canada nicolas gautier
- IRSA , France jean-luc BIGOT
- Segyero 365 hospital , Korea (South) Hee sun Yang
- Myongi , Korea (North) Moon soon-young
- 寃쎈 , Korea (South) In Kim
- Seoul St Mary Hospital , Korea (South) Chaehun Lim
- Kohka Public Hospital , Japan Akitoshi Inoue
- Mallinckrodt Institute of Radiology , United States Naganathan Mani
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Hanyang university medical center , Korea (South) YOONAH SONG
- Emory University Department of Radiology , United States Travis Henry
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- NASA SCANS , India RAKESH BHATIA
- CHRU lille , France manuel toledano
- Vikram hospital , India Pravin Mahadevappa
- Beaulieu clinic Geneva , Switzerland gilles GENIN
- Azienda Ospedaliera San Gerardo , Italy Gabriele D
- Fukuyama daiichi Hospital , Japan Mototsugu Saeki
- CH de la C�e Basque , France Paul ARDILOUZE
- Samsung medical center , Korea (South) Sanghee Lee
- Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh

▶ Correct Answer as Differential Diagnosis : 2/78, 2.6%

- NDMVP Nashik , India Imran Jindani
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK

▶ Semi-Correct Answer : 3/78, 3.8%

- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Shree Diagnostics , India amol jagdale
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 721 Date 2011-08-22

Discussion

No. of Applicants : 78