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Symptomatic Elastofibroma Dorsi Initially Presumed to Be a Subscapular Lipoma: Diagnostic Clues From Dynamic Ultrasonography and Intraoperative Findings

Year: 2026

Type: article

Abstract: Elastofibroma dorsi (ED) is a benign fibroelastic pseudotumor that classically arises in the deep infrascapular region. Although characteristic cross-sectional imaging may establish the diagnosis, a symptomatic subscapular mass may initially be approached as a more common benign soft-tissue lesion when imaging is limited to ultrasonography. We report a 63-year-old woman with a progressively enlarging left subscapular mass associated with persistent pain and discomfort. The initial clinical impression was a probable lipoma, and the patient requested removal because of ongoing symptoms. Targeted ultrasonography demonstrated a 35.3 × 8 mm heterogeneous, irregularly marginated, avascular lesion closely related to a rib. Its apparent dimensions varied with movement, and forward positioning of the arm was required to displace the scapula and obtain an adequate acoustic window. Because the lesion was readily localized and excision had already been selected for progressive growth and symptoms, computed tomography or magnetic resonance imaging was not obtained. At surgery, the lesion was firm, fibrous, poorly circumscribed, and tightly adherent to the deep muscular and costal planes rather than lipomatous, prompting intraoperative suspicion of ED. Muscle-sparing en bloc excision was completed without pleural entry or apparent intraoperative complication. Histopathology showed dense collagen, abnormal thick fragmented elastic fibers, and interspersed mature adipose tissue without atypia, mitotic activity, necrosis, or malignancy, confirming ED. At the documented postoperative follow-up visit, the patient had no pain, seroma, infection, or clinical evidence of recurrence. This case emphasizes that a growing, painful deep subscapular mass clinically presumed to be a lipoma warrants attention to scapulothoracic anatomy and dynamic sonographic behavior. When ultrasonographic findings are non-specific, cross-sectional imaging may improve preoperative recognition, while the characteristic intraoperative anatomy can provide an important diagnostic clue.

Source: Cureus

DOI: 10.7759/cureus.116909