Elastofibroma Dorsi: An Unusual Cause of Shoulder Pain and Snapping Scapula
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Elastofibroma dorsi is a benign lesion of fibroelastic tissue, located at the lower pole of the scapula, deep to serratus anterior muscle and often attached to the periosteum of the ribs. The lesion is usually seen in patients over the age of 50 years, commonly in women. It is not uncommonly mistaken as a malignant tumor because of its size and location deep to periscapular muscles. The pathogenesis is still unclear but it has been suggested to involve reactive hyperproliferation of fibroelastic tissue due to repetitive microtrauma by friction between the scapula and the thoracic wall, degenerative or neoplastic processes. The usual presentation is long history of swelling and occasionally pain, discomfort or snapping of the scapula. We present a series of eight patients with elastofibroma dorsi. Most of patients presented with swelling in the infrascapular region. In three cases the lesion was painful, and two cases presented with snapping scapula. The ratio of women/men was 5/3 with a mean age at diagnosis of 57 years (range 44 — 71). The tumor size ranged from 4 to 10 cm. In 25% of cases the lesion was bilateral. The diagnosis was based on clinical presentation and confirmed by CT in 4 patients, MRI in 2 patients and tnicut biopsy in 2 patients. All 8 patients were treated surgically under general anaesthesia, by complete marginal resection of the lesion. In the postoperative period we reported one case with seroma and another case with small haematoma. In the follow up period there have been no recurrences.