Bilateral elastofibroma dorsi: A case report.

INTRODUCTION: Elastofibroma dorsi(EFD) is slow-growing, benign, soft tissue tumor of unclear pathogenesis, typically located at the subscapular region of elderly people. It may be unilateral or bilateral. As it exhibits benign behavior, it should be surgically removed only in symptomatic patients. Magnetic resonance imaging (MRI) is a useful tool for assessment of EFD and can potentially help avoid the need for unnecessary biopsy and surgery. PRESENTATION OF CASE: A 62-year-old woman presented with 2 years complaint of back pain, particularly aggravated with shoulder movements and swelling with bilateral elastofibroma dorsi. Both masses were totally excised with bilateral posterolateral subscapular incision. Symptoms were completely controlled and significant discomfort from the surgical procedure was completely resolved with in a few weeks interval from the operation. DISCUSSION: The pathogenesis of the EFD still remains unclear. Elastofibroma dorsi has an unspecific clinical presentation and can be confused with other tumors of the periscapular region Imaging studies are useful for diagnosis. CONCLUSION: Elastofibroma dorsi is benign soft tissue tumor mostly observed in the subscapular regions of elderly female patients. The surgery is indicated in symptomatic cases and must be confined to simple excision of the lesion.

Carotid stenosis evaluation by 64-slice CTA: comparison of NASCET, ECST and CC grading methods.

Purpose is to evaluate the intraobserver and interobserver variability of the North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trial (ECST) and Common Carotid (CC) methods, which are used to measure the degree of ICA stenosis, using 64-slice CT angiography and to compare the measurements made by these three methods. 88 cases (111 carotid arteries) were included in the study. Carotid CTA was performed by a 64 slice scanner (Toshiba, Aqullion 64).Two radiologists measured the degree of carotid stenosis by using NASCET, ECST and CC methods. Intraobserver and interobserver variability of each method was determined by intraclass correlation coefficient (ICC), Bland-Altman plots and kappa and linear weighted kappa statistics. The relation between the measurements was assessed by correlation coefficient (with linear and quadratic methods). Correlation coefficients showed that there is linear correlation between the measurements made by the three methods. The degree of stenosis measured with the NASCET method had the lowest value, while the corresponding values measured with the ECST and CC methods were close to each other. ICC and Bland-Altman plots showed high intra and inter observer agreement for NASCET, ECST and CC methods whereas kappa statistics showed moderate to substantial agreement. CC method had slightly higher agreement when compared with the other two methods. Intra and interobserver agreement is high for NASCET, ECST and CC methods however CC method has a slightly higher reproducibility. There is linear correlation between the measurements made by the three methods.

Prevalence and extent of coronary artery disease determined by 64-slice CTA in patients with zero coronary calcium score.

The purpose of the study was to assess the presence and extent of atherosclerosis determined by 64-slice CTA in patients with 0 coronary calcium score (CACS) and to evaluate the affect of demographic features and risk factors on the atheroma burden of these patients. 883 cases (378 (42.8%) male, 505 (57.2%) female, mean age 51.28) with zero CACS were included in the study. Cases underwent CTA because of carrying risk factors or having chest pain or atypical symptoms. A non-enhanced CT scan was obtained for calcium scoring immediately before CTA in all cases. CT examinations were performed by 64-slice scanner (Toshiba, Aquillon 64, Toshiba Medical Systems, Otowara, Japan). Coronary artery disease (CAD) was graded according to CTA findings and five groups were defined. In 703 cases (79.6%) CTA was normal while 180 (20.4%) cases had positive CTA findings and 43 cases (4.9%) had CTA obstructive lesion. Cases with positive CTA findings were significantly older than those with normal CTA Diabetes was a significant risk factor of CAD in both male and female cases. Dyslipidemia was associated with CAD in males and family history of CAD was a significant risk factor for females with positive CTA findings. This study demonstrated that considerable amount of patients with zero CAC score have positive CTA findings. Age and diabetes are the risk factors, which were associated with positive CTA findings in both sexes. Dyslipidemia was a significant risk factor in males and family history of CAD in females. Especially in patients with risk factors CTA is better than CAC scoring in determining the atheroma burden.