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Elastofibroma : Clinical Features & Imaging

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Clinical Features: Elastofibroma arises in the elderly patients (peak incidence in 6th and 7th decades) with a strong female predominance (F:M=4:1). Many patients have history of repetitive manual labor. It is only rarely reported in children and young adults.

It presents as a deep-seated, slow-growing mass on the back between inferomedial portion of scapula and the thoracic wall, deep to the serratus anterior and latissimus dorsi muscles. It is usually attached to the periosteum of the underlying ribs (6th to 8th). About 50% of cases are bilateral; unilateral masses are more common on the right side.

About 50% of the patients are asymptomatic. The remainder experience mild pain, tenderness or discomfort, limitation of range of motion, and a sensation of scapular snapping or clicking on shoulder movement. Similar lesions have been reported in extrascapular sites, including axilla, hip, posterior elbow, eye and oral cavity. Rare lesions arise in the viscera such as gastrointestinal tract and trachea.

Imaging: Plain radiographs are usually normal but may show a soft tissue mass without calcification. On CT (shown here) and MRI, elastofibroma appears as a poorly-circumscribed, crescent shaped, heterogenous soft-tissue mass in the infrascapular or subscapular region. The attenuation of signal intensity is similar to the adjacent skeletal muscle. Layers of adipose tissue are usually found within the mass.

Case courtesy of Dr Safwat Mohammad Almoghazy, Radiopaedia.org. From the case rID: 54015

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