Objective: We report radiologic findings in 12 patients with elastofibroma dorsi to heighten radiologist awareness of the imaging characteristics of these benign, often asymptomatic lesions. Because these lesions can usually be diagnosed on the basis of their imaging characteristics, increased awareness of these characteristics will decrease misdiagnosis of these lesions as malignancies and avoid unnecessary biopsies and surgeries.
Materials and methods: We retrospectively reviewed the radiology and pathology of nine patients with surgically excised elastofibromas and the radiology of three patients with radiologically diagnosed elastofibromas.
Results: Twenty-one elastofibromas were imaged in 12 patients. Female-to-male ratio was 5:1; mean age was 65 years old. Of the nine patients in whom both sides of the chest wall were imaged, all (100%) had bilateral elastofibromas. Nineteen elastofibromas (90%) had the typical CT and MR appearances described in the literature: a poorly circumscribed, heterogeneous soft-tissue mass, with tissue of attenuation or signal intensity similar to that of skeletal muscle interlaced with strands of fat. One elastofibroma imaged twice over a 4-year period showed interval growth. All elastofibromas were sub- or infrascapular or in both locations. Of the 21 elastofibromas imaged, only four were perceived by the initial interpreting radiologist, and of these, only one was correctly diagnosed.
Conclusion: Our study shows that many radiologists may not be aware of the diagnosis of elastofibroma, as few of the cases in our series were perceived or correctly diagnosed by the interpreting radiologist. Our cases show many of the classic findings of elastofibromas described in the literature. In addition, our series shows that elastofibromas are commonly bilateral, a feature that has not been strongly emphasized in the literature but one that is helpful in making the radiologic diagnosis. The finding of a similar contralateral lesion, when present, virtually eliminates malignancy from the differential diagnosis and further supports the presumptive diagnosis of elastofibromas. Increased awareness of the characteristic appearance and location of these benign, often asymptomatic lesions will increase radiologic diagnosis, decrease the need for biopsy, and decrease surgical removal of elastofibromas as presumed malignancies.