Symptomatic Elastofibroma Dorsi Initially Presumed to Be a Subscapular Lipoma: Diagnostic Clues From Dynamic Ultrasonography and Intraoperative Findings.
- 1General Surgery, Hospital Regional Valentín Gómez Farías, Zapopan, MEX.
- 2General Surgery, Presidente Lázaro Cárdenas del Río, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Chihuahua, MEX.
- 3General Surgery, Hospital Regional de Monterrey, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Monterrey, MEX.
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.
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BibTeX
@article{fuentes2026symptomatic,
title = {{Symptomatic Elastofibroma Dorsi Initially Presumed to Be a Subscapular Lipoma: Diagnostic Clues From Dynamic Ultrasonography and Intraoperative Findings.}},
author = {Sergio Miguel Suárez Fuentes and Mauro A Cardenas and Andrea Nallely Garza-Cisneros and Luis F Hernández González and Andrea P Rizo Navarrete and Karen A Horta Muñoz and Arely S Martínez Roacho and María N Sandoval Arreola and Miroslava A Durán Sandoval},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116909},
url = {https://europepmc.org/article/MED/42928936},
note = {CC BY},
}
RIS
TY - JOUR
TI - Symptomatic Elastofibroma Dorsi Initially Presumed to Be a Subscapular Lipoma: Diagnostic Clues From Dynamic Ultrasonography and Intraoperative Findings.
AU - Sergio Miguel Suárez Fuentes
AU - Mauro A Cardenas
AU - Andrea Nallely Garza-Cisneros
AU - Luis F Hernández González
AU - Andrea P Rizo Navarrete
AU - Karen A Horta Muñoz
AU - Arely S Martínez Roacho
AU - María N Sandoval Arreola
AU - Miroslava A Durán Sandoval
PY - 2026
DA - 2026/09/25
JO - Cureus
DO - 10.7759/cureus.116909
UR - https://europepmc.org/article/MED/42928936
AB - 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.
SN - 2168-8184
ER -