Atypical Appearance of Elastofibroma Dorsi on MRI: Case Reports and Review of the Literature

Abstract

Three patients with histologically proven elastofibroma dorsi underwent MRI, using T1-weighted, T2-weighted, STIR (short inversion time inversion recovery), and contrast-enhanced SE sequences. All lesions typically displayed low signal intensity masses interspersed with areas of high signal intensity on T1- and T2-weighted SE images. Contrary to prior reports, two patients showed marked enhancement of the mass after administration of Gd-DTPA. Although the characteristic signal intensity on conventional T1- and T2-weighted images may lead to the early diagnosis of this rare tumor, radiologists should be aware that marked contrast enhancement may be representative in elastofibroma dorsi.

Elastofibroma dorsi: magnetic resonance imaging findings in two cases

“…Although atypical for elastofibromas, mild or marked enhancement have been reported in several cases (6,8). Histological examination did not reveal a difference between the tissue composition of the elastofibromas, showing mild or marked enhancement after the administration of gadopentate dimeglumine (8). However in cases with marked contrast enhancement, a strong vascularity was demonstrated on histologic workup (8).…”

“…However in cases with marked contrast enhancement, a strong vascularity was demonstrated on histologic workup (8). Although the basic nature of the contrast enhancement in elastofibromas is not well understood, one should know that marked contrast enhancement could be seen in elastofibromas (8). The differential diagnosis of a periscapular lesion with a signal intensity similar to skeletal muscle is limited and includes lesions with decreased cellularity like extraabdominal desmoid, neurofibroma, cicatricial fibroma and malignant fibrous histiocytoma (9).…”

“…Normal structures can also mimic elastofibroma dorsi, like the inferior fibers of the serratus anterior muscle, which has a globular appearance especially on CT sections. As elastofibroma contains strands of soft tissue of fat signal intensity differential diagnosis must also include lipomatous lesions such as lipoma or liposarcoma and lesions containing blood, such as hemangioma, hematoma and intralesional hemorrhage (8). The variable enhancement pattern of the lesion is not a particularly striking feature (8).…”

Elastofibroma Dorsi: An Uncommon Soft Tissue Tumor

“…Minor micro traumas due to friction between the inferior border of scapula and chest wall may cause reactive fibromatosis (9). Hypoperfusion by the enlargement of the lesion, enzyme deficiency, elastotic degeneration have also been discussed for pathogenesis (10,11).…”

FDG PET/CT Appearance of Multi-Regional Elastofibroma: Original Image

“…10,11 Enhancement after the administration of gadopentetate dimeglumine has been reported. 12 Thoracic CT has a main role in the diagnosis, and the classical pattern is poorly defined inhomogeneous soft-tissue density with an attenuation approximately the same as that of skeletal muscle in the subscapular region. 13 Normal structures can also mimic elastofibroma, like the fibers of the muscles, which have a globular appearance especially on CT images.…”