Elastofibroma Dorsi: experience of a single center.

OBJECTIVE: Elastofibroma dorsi (ED) is a rare benign tumor located in the subscapular region. The aim of this study was to evaluate our clinical findings, surgical approach, and management of ED patients based on single-center data with the relevant literature. METHODOLOGY: A retrospective evaluation was conducted on 20 patients who were operated on for ED. RESULTS: Of the 16 (80%) female patients and 4 (20%) male patients, the main complaint was swelling (80%), and 10 cases (50%) had unilateral involvement. All patients were operated on using standard surgical procedures. Despite a long follow-up period (6-53 months, mean of 26.6 months), no recurrences were observed. Two patients (10%) required simple needle aspiration due to post-operative seroma, and one patient, due to infection, required evacuation (5%). CONCLUSION: Although rare, ED should not be overlooked in patients with swelling in the back region. Our data suggests that surgery can be safely performed in such patients after a clinical and radiological diagnosis of ED has been established.

OBJETIVO: Evaluar los hallazgos clínicos, el enfoque quirúrgico y el manejo de los pacientes con urgencias a partir de los datos de un solo centro y la literatura relevante. MÉTODO: Se realizó una evaluación retrospectiva de 20 pacientes que fueron operados de ED. RESULTADOS: En los 16 (80%), pacientes del sexo femenino y cuatro (20%) del sexo masculino, la queja principal fue la tumefacción (80%) y 10 casos (50%) tuvieron afectación unilateral. Todos los pacientes fueron operados utilizando procedimientos quirúrgicos estándar. Con un largo periodo de seguimiento (6-53 meses, media de 26.6 meses), no se observaron recurrencias. Dos pacientes (10%) requirieron aspiración con aguja simple por seroma posoperatorio y un paciente (5%) requirió evacuación por infección. CONCLUSIONES: Aunque es raro, el ED no debe pasarse por alto en pacientes con hinchazón en la región de la espalda. Nuestros datos sugieren que la cirugía se puede realizar de manera segura en estos pacientes después de haber establecido el diagnóstico clínico y radiológico de ED.

Superior scapular location: An overlooked albeit frequent finding in elastofibroma dorsi.

PURPOSE: To explore the frequency of superior scapular elastofibroma dorsi in a large patient series with elastofibroma dorsi. METHODS: 136 chest CTs from January 2016 to July 2022 reporting elastofibroma dorsi were retrospectively analyzed. Three radiologists assessed the number, size, and location of elastofibroma dorsi. Continuous variables underwent two-tailed t-tests with p < 0.05. Inter-observer agreement was assessed by using Cohen's Kappa values. RESULTS: In 136 patients (mean age, 75.9 +/- 9.8 years; 117 female), 330 elastofibroma dorsi were found. Six (4.4 %) patients had single, 87 (64 %) double, 22 (16.2 %) triple and 21 (15.4 %) quadruple lesions. All single and double lesions were in the inferior scapular regions. 43 (31.6 %) patients had superior scapular lesions in addition to inferior scapular elastofibroma dorsi. Inferior scapular elastofibroma dorsi was significantly larger than superior scapular elastofibroma dorsi. The probability of a right superior lesion was significantly higher in patients with a larger right inferior lesion. Inter-observer agreement was very good for experienced radiologist (κ = 94.1) and good for other radiologists (κ = 79.4 and κ = 78). CONCLUSION: In contrast to current belief, superior scapular elastofibroma dorsi accompanying the typical inferior scapular lesions is not uncommon and can even manifest bilaterally. To the best of our knowledge, this is the first case series reporting prevalence of quadruple elastofibroma dorsi.

Benign tumors of the chest wall.

Benign tumors of the chest wall are rare tumors that might arise from all the tissues of the chest: vessels, nerves, bones, cartilage, and soft tissues. Despite benign features, these tumors can have several histological characteristics and different behaviors. Even if they do not influence life expectancy, rarely they may have a potential risk of malignant transformation. They can cause several, oft, unspecific symptoms but more than 20% of affected patients are asymptomatic and are being diagnosed incidentally on chest radiograph or computed tomography scan. Pain is the most common described symptom. Together with a detailed medical history, a rigorous and meticulous clinical and radiological assessment is mandatory. If radiological features are unclear or in case surgery could not be performed, a biopsy should be indicated to establish a diagnosis. Radical surgical resection can often be offered to resect and cure these neoplasms, but this is might not be true for all types of tumors and, in some cases, their dimension or position might contra-indicate surgery. Given the rarity of these tumors, there is a lack of treatment's guidelines and prospective trials that include a significant number of patients. This review discusses, according to the latest evidence, the histological features and the best treatment of several chest wall benign tumors.

The First-Reported Presentation of Quadruple Locations of Elastofibroma Dorsi: A Case Report and Review of the Literature.

Elastofibroma dorsi (EFD) is an uncommon benign tumor of mesenchymal origin that usually occurs in the subscapular region. Bilateral and triple EFD are frequently reported in the literature but cases with more lesions have never been described. Our patient is a 50-year-old female with quadruple locations of bilateral suprascapular and subscapular EFD who presented with left shoulder pain and swelling over the affected area. Clinical presentation, computed tomography (CT) and magnetic resonance imaging (MRI), and biopsy were consistent with EFD. Therapeutic excision was performed and successfully alleviated the patient's discomfort. This report presents the first case of quadruple locations of EFD and highlights the value of MRI in the diagnosis of EFD, especially when there are multiple masses with indistinct margins are deeply located in the chest wall.

Elastofibroma dorsi: diagnóstico y seguimiento en atención primaria / Elastofibroma dorsi: Diagnosis and follow-up in primary care

Objetivo Presentar una serie de pacientes con elastofibroma dorsi (ED) para recordar la patología y justificar su manejo diagnóstico y terapéutico en el ámbito de la atención primaria. Materiales y métodos Estudio retrospectivo observacional y longitudinal de 12 pacientes con 18ED. Se analizaron las características epidemiológicas, clínicas y de imagen. Los resultados del tratamiento se evaluaron atendiendo al dolor (escala EVA), la función del hombro (escala de Constant y Murley) y la calidad de vida (escala EuroQol-5 dimension [EQ-5D]). El tiempo medio de seguimiento de los casos fue de 60,5meses (5años, RIC: 1-161meses). Resultados Seis pacientes fueron hombres y seis fueron mujeres, con edad media al diagnóstico de 59años. El diagnóstico de sospecha en todos los casos fue clínico y de imagen. Solo tres precisaron intervención quirúrgica. Los resultados de todos fueron satisfactorios. Conclusiones Tanto el diagnóstico como la indicación del tratamiento de un ED puede hacerse en el ámbito de la atención primaria. En los casos típicos, que son mayoría, la historia clínica y una ecografía permiten un diagnóstico de certeza. La indicación terapéutica conservadora o quirúrgica depende de la decisión del paciente informado. Cuando existen dudas diagnósticas o el paciente desea la resección quirúrgica de la tumoración, habría que derivar al paciente al especialista hospitalario (AU)

Objective To present a series of patients with elastofibroma dorsi (ED) in order to recall the pathology and justify its diagnostic and therapeutic management in the primary care setting. Materials and methods Retrospective observational and longitudinal study of 12 patients with 18ED. Epidemiological, clinical and imaging characteristics were analysed. Treatment outcomes were assessed in terms of pain (VAS scale), shoulder function (Constant and Murley scale) and quality of life (EuroQol-5 dimension scale, EQ-5D). The mean follow-up of the cases was 60.5months (5years, range 1-161months). Results Six patients were male and six were female, with a mean age at diagnosis of 59years. The diagnosis of suspicion in all cases was based in clinical and imaging findings. Only three required surgery. The results of all were satisfactory. Conclusions Both the diagnosis and the indication for treatment of an ED can be made in the primary care setting. In typical cases, which are the majority, the clinical history and an ultrasound study allow a diagnosis of certainty. The indication for conservative or surgical treatment depends on the informed patient. When there are diagnostic doubts or the patient wishes surgical resection of the tumour, the patient should be referred to a hospital specialist (AU)

[Elastofibroma dorsi: Diagnosis and follow-up in primary care]. / Elastofibroma dorsi: diagnóstico y seguimiento en atención primaria.

OBJECTIVE: To present a series of patients with elastofibroma dorsi (ED) in order to recall the pathology and justify its diagnostic and therapeutic management in the primary care setting. MATERIALS AND METHODS: Retrospective observational and longitudinal study of 12 patients with 18ED. Epidemiological, clinical and imaging characteristics were analysed. Treatment outcomes were assessed in terms of pain (VAS scale), shoulder function (Constant and Murley scale) and quality of life (EuroQol-5 dimension scale, EQ-5D). The mean follow-up of the cases was 60.5months (5years, range 1-161months). RESULTS: Six patients were male and six were female, with a mean age at diagnosis of 59years. The diagnosis of suspicion in all cases was based in clinical and imaging findings. Only three required surgery. The results of all were satisfactory. CONCLUSIONS: Both the diagnosis and the indication for treatment of an ED can be made in the primary care setting. In typical cases, which are the majority, the clinical history and an ultrasound study allow a diagnosis of certainty. The indication for conservative or surgical treatment depends on the informed patient. When there are diagnostic doubts or the patient wishes surgical resection of the tumour, the patient should be referred to a hospital specialist.

Elastofibroma Dorsi Detected Incidentally on Chest Computed Tomography: The Prevalence and Reporting Rate in Radiology Reports.

Background Elastofibroma dorsi (ED) is an uncommon benign connective-tissue tumor, usually seen in the subscapular region of women after the fifth decade. The study aimed to determine the prevalence, radiological characteristics, and the rates of mention in the initial radiology reports of ED incidentally detected by chest computed tomography (CT) imaging in a large population.  Methodology This study was conducted at Hitit University, Erol Olçok Training and Research Hospital Radiology Department in Çorum, Turkey. A total of 3,299 patients (1,554 females, 1,745 males) who underwent non-contrast chest CT for various reasons were included in this retrospective study. The presence, side, thickness, and density of ED were investigated in these patients. Differences in gender and laterality were assessed statistically. It was also reviewed whether it was stated in the initial radiology report or not. Results ED was detected in 79 (2.4%) of 3,299 patients, in 60 (75.9%) females and 19 (24.1%) males with a median age of 57.5 years (range, 18-99 years). The risk of ED presence was determined to be 3.65-fold in females than in males. In the cases determined with ED, the median age was 75 years (range, 53-96 years), and ED was not determined in any patient aged <50 years. A statistically significant correlation was determined between age and the presence of ED (p < 0.001). No statistically significant correlation was found between age and ED thickness or density (p = 0.602, p = 0.233, respectively). It was noted that none of the patients were diagnosed in the first radiological report. Conclusions ED can be easily overlooked on cross-sectional examinations because of the similar appearance and density to adjacent structures. Knowledge of the characteristic radiological features of these lesions and increased awareness of radiologists will make early diagnosis possible in asymptomatic cases.

Management of Symptomatic Elastofibroma Dorsi: A Case Report and Literature Review.

Elastofibroma dorsi (ED) is a rare tumor that most often occurs in the subscapular and infrascapular region between the thoracic wall, serratus anterior, and latissimus dorsi muscle. Based on a review of the literature, ED has been deemed an extremely rare entity. However, the incidence may be greater and is difficult to determine as the majority of ED being asymptomatic and therefore undiagnosed. Surgical excision is commonly performed when patients present with pain associated with ED. This being the case, it is important to evaluate the factors contributing to the pain seen in these patients and to evaluate the risks vs benefits of intervening in symptomatic ED patients who present for possible surgical intervention. We herein report a case of bilateral ED, situated in the upper back with only the right side being symptomatic in a 56-year-old male laborer. Due to pain in the right upper back, the patient underwent surgical removal of the ED. The postoperative course was uneventful and the patient had an excellent recovery. A review of the literature showed no correlation between pain on presentation and tumor size or location. Major complications of treating these patients include seroma or hematoma formation which according to the literature can be avoided using postoperative tube drainage and compressing bandages.

Does elastofibroma dorsi occur more frequently on the same side with the dominant hand?

Background: In this study, we aimed to investigate the correlation between the side of elastofibroma dorsi formation and the dominant-hand of the patients we operated. Methods: A total of 84 patients with elastofibroma dorsi (12 males, 72 females; mean age: 55.5±7.0 years; range, 43 to 74 years) were retrospectively analyzed between April 2007 and May 2019. Dominant hand, location, size, sex, age, occupations and follow-up of the mass were recorded and the pre- and postoperative Visual Analog Scale scores were noted. Results: The mean symptom duration was 9.5±7.8 (range, 3 to 48) months. The lesions were located on the right in 49 (58.3%), on the left in 16 (19%) and bilateral in 19 (22.6%). There was no significant difference between the mass size and age, symptom duration and complication development (p=0.129). A significant relation was found between the formation of the mass on the side of the dominant hand (p=0.010). A significant difference was found between the pre- and postoperative Day 90 Visual Analog Scale scores (p<0.001), indicating a significant decrease in the pain scores. Conclusion: Elastofibroma dorsi has good clinical results after surgical resection. In our series, the patients had significantly more elastofibroma dorsi on their dominant-hand side.

Subscapular elastofibrolipoma treated with marginal resection: two case reports.

BACKGROUND: Elastofibroma dorsi is a rare benign tumor of soft tissue, typically under the lower angle of the scapula. Its specific location and distinctive clinical symptoms can provide enough information for diagnosis. Nevertheless, pathological confirmation by biopsy may be needed to rule out other malignancies. CASE PRESENTATION: Here, we present two cases of 63-year-old and 49-year-old female Asian patients who came to us with the chief complaint of pain and bulging in their shoulders. Both patients had rubbery and mobile masses. Also, shoulder movements were not restricted in the examination; however, the patients expressed pain during movements. Computed tomography scans were compatible with the diagnosis of elastofibroma dorsi. Surgical excision was performed for both cases owing to the symptomatic nature of the masses, and histopathological findings confirmed the diagnosis. CONCLUSION: Elastofibroma dorsi is a benign pseudotumor presenting with an uncomfortable feeling in the shoulder with movement in older females. In typical symptom-free cases of elastofibroma dorsi, observation is sufficient, while in symptomatic patients or if there is suspicion of malignancy, complete resection with marginal resection is the treatment of choice.

Inverted intercostal hernia of elastofibroma dorsi mimicking well-differentiated liposarcoma in the chest wall.

Elastofibroma dorsi is a well-known benign chest wall tumor. Herein, we present a case in which an elastofibroma protruded into the thoracic cavity, leading to inverted intercostal hernia. Imaging revealed a soft tissue mass containing fat, typical of elastofibroma dorsi; however, precise diagnosis was difficult owing to the location of this mass that protruded into the thoracic cavity. Liposarcoma had to be ruled out because it was a growing fat-containing mass. Considering that the tumor moved while the patient was undergoing computed tomography-guided biopsy in the prone position, a diagnosis of inverted intercostal hernia of elastofibroma dorsi was made. We report this case with a review of current literature.

Prevalence of elastofibroma dorsi found incidentally upon chest computed tomography scan: A tertiary care center experience.

OBJECTIVES: To determine the prevalence and demographic data regarding incidentally encountered elastofibroma dorsi (EFD) in the Saudi population-based on chest CT (computed tomography) scans. METHODS: This retrospective study was carried out on 4,435 chest CT examinations that were collected between January 2014 and December 2016 in Riyadh, Saudi Arabia. One musculoskeletal radiologist who was unaware of the patients' clinical presentations or reasons for CT study reviewed the 4,435 chest CTs prospectively, searching for soft tissue tumors in the subscapular region. RESULTS: Elastofibroma dorsi was incidentally confirmed via CT scan in 36 of the 4,435 patients, including 8 males and 28 females, with a mean age of 76.6 years, yielding a prevalence of 0.8%. Elastofibroma dorsi was more common in females, with a 3.3-fold higher prevalence (77.8%) as compared to males (22.2%); however, this difference was not statistically significant (p>0.05). Twenty-five (69.44%) patients had unilateral EFD and 11 (30.56%) had bilateral EFD. Right-sided EFD was encountered in 60% of females and 50% of males. Furthermore, there was no statistically significant correlation between the size of EFD and the patient's gender or age (p>0.05). CONCLUSION: Elastofibroma dorsi is a rare but uncommon incidental finding on routine chest CT examination encountered in 0.8% of elderly Saudi patients.

Elastofibroma dorsi: a case report of bilateral occurrence and review of literature.

BACKGROUND: Elastofibroma dorsi (ED) is a benign slow growing soft tissue tumor that is most frequently located subscapular. The prevalence is estimated to be 2% on imaging studies in individuals over 60 years old and might occur bilaterally. The etiology, however, remains unclear. CASE PRESENTATION: This report presents the case of a man with bilateral ED. He first presented at the age of 49 with a subscapular ED on the right side and again at the age of 53 with a subscapular ED on the left side. At both times, diagnosis of ED was histopathologically confirmed after surgical resection. And, again at both times, the postoperative course was characterized by seroma development. DISCUSSION: This report shows a brief review of literature on ED. It contains a summary of the current data on prevalence, etiology, clinical presentation, diagnosis, histopathological findings, surgical treatment and postoperative management. It also includes a flowchart for diagnostic and therapeutic approach. CONCLUSIONS: ED might present bilaterally, though not necessarily affecting both sides simultaneously. In order to diagnose ED MRI is ought to be sufficient. Invasive procedures, i.e. complete surgical excision, are mandatory to treat symptomatic ED, although such surgical procedures are often complicated by seroma formation.

Elastofibroma Dorsi: Case Report with Point of Care Ultrasound Primary Care Applications.

Elastofibroma dorsi (ED) is an uncommon, benign, slow-growing soft tissue tumor with an unclear etiology. The growth often presents as a local deformity with mild pain or discomfort in the subscapular region of geriatric populations. The following paper discusses a 73 year old female with mildly painful ED who presented to her primary care physician. We further review current literature on epidemiology, utilization of point of care ultrasound (POCUS) and treatment options.

Surgery for elastofibroma dorsi: optimizing the management of a benign tumor-an analysis of 70 cases.

BACKGROUND: Elastofibroma dorsi (ED) is a benign soft-tissue tumor of the chest wall located near the tip of the scapula. Clinical presentation includes swelling, pain and impairment of shoulder movements. The present literature relies only on few small case series. The aim of this study was to analyze the surgical management of ED, focusing on the debated topics regarding preoperative evaluation, operative technique, post-operative outcome and follow-up. METHODS: We conducted a single-center retrospective cohort analysis of patients operated for ED between 2003 and 2018. Diagnostic techniques were ultrasonography (US), computed tomography (CT-scan) and magnetic resonance imaging (MRI). CT-scan represented our preferred imaging study for preoperative assessment. Surgery was proposed for symptomatic and/or large lesions. Marginal excision through a muscle-sparing approach was performed. An open-door follow-up policy was adopted. All clinical, radiological, perioperative and pathological variables were matched in a univariate analysis. A multivariate analysis was performed to investigate risk factors for postoperative complications. Correlations analysis between radiological and pathological measurements of elastofibroma was conducted. RESULTS: Seventy elastofibromas were excised in 59 patients. Mean age was 59 years and female prevalence was 59%. All elastofibromas were completely resected with no recurrence. Postoperative complications rate was 17%. Complications were mild in most cases. At the univariate analysis, patients with body mass index (BMI) >25 had a longer operative time (P=0.048), patients on antiplatelet medications experienced a prolonged drainage time (P=0.006) and a higher rate of complications (P=0.038); the occurrence of complications resulted in prolonged drainage time (P=0.047) and length of stay (P=0.023). A BMI ≤25 was the only independent risk factor for postoperative morbidity (OR 8.71, P=0.024). CT-scan showed the highest correlation with pathological size (r=0.819), US the lowest (r=0.421). CONCLUSIONS: Marginal resection through a muscle-sparing approach is safe and effective for the treatment of ED. CT-scan can be adequate for preoperative assessment. Giving the benign nature of the lesion and the absence of recurrence after complete resection, an open-door follow-up may be appropriate.

Bilateral and atypical localized elastofibroma dorsi in a patient with shoulder and back pain: A case report.

A 61-year-old woman presented with localized back pain at the left inferomedial border of the scapula and left shoulder pain. On physical examination, a soft tissue mass was detected on the left scapula. Magnetic resonance imaging showed a mass at the left suprascapular region and another mass in the left infrascapular region. A Tru-Cut biopsy of the lesion at the left suprascapular region was obtained due to atypical localization. Pathological examination was consistent with an elastofibroma. During wire-marking, another mass was detected at the right infrascapular region. Three mass lesions were excised on consecutive operations. During follow-up, the patient reported reduced shoulder and back pain.

Prevalence of elastofibroma dorsi on CT: Is it really an uncommon entity?

OBJECTIVE: The aim of this study was to determine the prevalence, demographic data of elastofibroma dorsi (ED) in adult population who had undergone chest CT examination and to discuss clinical, and radiological presentations, and treatment options of ED. METHODS: We retrospectively reviewed 4074 chest CT examinations for ED from July 2014 to April 2015. Lesion size, side, and patient demographics were analyzed for positive cases of ED. The initial radiology reports of patients with ED were also reviewed. RESULTS: Of the 4074 patients, 111 patients (2.73%) (77 women and 34 men; mean age: 68.2 years; range: 35-91 years) had a total of 168 ED. The females had a 1.96 -fold higher prevalence of ED than the males (OR, 1.96; 95% CI, 1.481-2.59). The mean lesion thickness was found to be significantly greater in the female patients compared with the male patients (p = 0.001). The prevalence of the disease was estimated to be 4.98 times higher in patients aged 65 years or older (CI 95%, 3.25-7.36). In 111 ED patients, the lesions were only noted in 9 patients' initial radiology report. CONCLUSION: Here, we present a prevalence study with the largest population in the literature concerning ED. Our study shows that ED is not as uncommon as previously thought and should be especially suspected in females and older age groups. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Extraordinary Presentation of Elastofibroma Dorsi After a Thoracotomy Procedure.

Elastofibroma dorsi is a reactive pseudotumor of connective tissue, typically located in the infrascapular region. Awareness of this benign entity is crucial for radiologists, as well as clinicians, to avoid misdiagnosis and potential patient harm. In this report, we present clinical and imaging findings of an elastofibroma dorsi after a thoracotomy procedure.