CT appearance of a deep elastofibroma dorsi mass beneath the scapula adjacent to the posterior chest wall

A 50-year-old man presented with a swelling at the inferior scapular region, pain during shoulder movement, and marked scapulothoracic crepitus. This pattern raises suspicion for elastofibroma dorsi, a benign deep soft-tissue lesion classically situated between the inferior scapula and the posterior chest wall.

Patient-friendly summary

The case in one minute

Elastofibroma dorsi may present as a shoulder problem rather than an obvious tumor. A mass at the inferior scapular border with pain or scapulothoracic crepitus should prompt examination of the infrascapular region and appropriate imaging.

Clinical category
Benign deep soft-tissue lesion
Anatomical site
Between the inferior scapula and posterior chest wall
Symptoms
Swelling, painful shoulder motion, and marked crepitus/snapping
Decision illustrated
Surgical excision for a symptomatic painful mass with mechanical crepitus
How should this page be used?For education and understanding clinical reasoning. It does not replace examination and review of the complete imaging. The supplied case source does not report long-term follow-up outcomes.

Related specialist resources

Age:50 years
Location:Inferior scapular region and posterior chest wall
Main presentation:Swelling with pain and crepitus during shoulder motion
Treatment illustrated:Surgical excision of the symptomatic mass

Why the Diagnosis Can Be Difficult

Elastofibroma dorsi is typically deep and slow growing. The mass may be subtle when the arm is resting, while the dominant symptoms can be pain, discomfort, snapping, crepitus, stiffness, or pain during shoulder motion. These complaints overlap with far more prevalent conditions, so the lesion can be missed if the assessment is limited to the glenohumeral joint.

What Can It Be Mistaken For?

The following are important clinical mimics and do not imply that this particular patient received each of these diagnoses. In undetected cases, symptoms may initially be attributed to:

  • Rotator cuff disease.
  • Subacromial impingement or bursitis.
  • Scapulothoracic bursitis and other causes of snapping scapula.
  • Periscapular muscular pain.
  • Cervical referred pain or cervical degenerative disease.
  • Other benign chest-wall/soft-tissue masses; atypical lesions also require exclusion of more aggressive soft-tissue tumors.

Accordingly, some patients may undergo analgesic treatment, physiotherapy, or shoulder-directed treatment before the infrascapular source is recognized. Persistent symptoms associated with a palpable swelling, scapular prominence, or reproducible crepitus should prompt examination of the scapulothoracic region and targeted cross-sectional imaging.

Clinical Examination: Look Beyond the Shoulder Joint

Examination should include the shoulder, scapula, and posterior chest wall. The lesion may become more apparent as the scapula moves away from the thoracic cage or with specific arm positions. An inferior-scapular mass associated with painful scapulothoracic motion or snapping strongly supports the diagnostic pathway toward elastofibroma dorsi.

Imaging

In this case, CT demonstrated a deep infrascapular soft-tissue mass adjacent to the chest wall. The characteristic location and internal fibrofatty appearance are important diagnostic clues. MRI is particularly useful when the lesion is atypical, when tissue characterization is needed, or when the relationship to adjacent muscles and the chest wall requires further definition.

Why Surgery Was Chosen

Not every radiologically identified elastofibroma dorsi requires resection. Management is primarily driven by symptoms and diagnostic certainty. This patient had a painful mass with pain on shoulder motion and pronounced mechanical crepitus; therefore, surgical excision was performed. The specimen was submitted for histopathologic assessment as part of standard surgical practice.

Operative and Imaging Figures

CT scan showing a deep infrascapular soft-tissue mass adjacent to the posterior chest wall, compatible with the typical location of elastofibroma dorsi.
Figure 1. Preoperative CT showing a deep infrascapular mass adjacent to the posterior chest wall.
Operative positioning and sterile preparation of the shoulder and scapular region before surgical excision.
Figure 2. Operative positioning and preparation allowing access to the infrascapular region.
Intraoperative exposure of the deep infrascapular surgical field during excision of the elastofibroma dorsi.
Figure 3. Intraoperative exposure of the deep infrascapular surgical field.
Excised elastofibroma dorsi specimen displayed next to a surgical scalpel for approximate scale.
Figure 4. Excised specimen displayed next to a scalpel for approximate scale.
Cut surface of the excised lesion showing the characteristic heterogeneous fibrofatty gross appearance.
Figure 5. Cut surface demonstrating the heterogeneous fibrofatty gross appearance.

Educational Message

Not all shoulder pain and crepitus originate inside the shoulder joint. Pain around the inferior scapula associated with swelling, snapping, or reproducible crepitus should trigger assessment of the scapulothoracic space.

Elastofibroma dorsi is a useful diagnostic lesson because a benign deep chest-wall lesion can clinically mimic common shoulder or cervical disorders. Recognition depends on combining the symptom pattern with a dynamic scapular examination and the characteristic infrascapular appearance on CT or MRI. This approach reduces the risk of prolonged, non-targeted treatment.

Selected References

  • Deveci MA, et al. Elastofibroma dorsi: Clinical evaluation of 61 cases and review of the literature. Acta Orthop Traumatol Turc. 2017;51(1):7-11. doi:10.1016/j.aott.2016.10.001.
  • Smith HG, et al. Elastofibroma dorsi: The clunking tumour that need not cause alarm. Ann R Coll Surg Engl. 2016;98(3):208-211. doi:10.1308/rcsann.2016.0064.
  • Daigeler A, et al. Elastofibroma dorsi - differential diagnosis in chest wall tumours. World J Surg Oncol. 2007;5:15.
Medical disclaimer: This case is presented for medical education and patient information. Individual diagnosis and treatment require clinical examination and review of the complete imaging and pathology data.

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