Working Diagnosis:
Elastofibroma dorsi.

Treatment:
Physical Therapy was consulted for scapular stabilization, rehabilitation, and osteopathic manipulative treatment, including rib raising, strain-counterstrain, and soft tissue techniques. <br> <br>Orthopedic Surgery was consulted to discuss whether surgical intervention was indicated for the suspected soft tissue mass.

Outcome:
After two months of physical therapy, the patient reported complete resolution of pain and weakness. <br> <br>Orthopedic Surgery recommended surveillance magnetic resonance imaging two months later. Follow-up imaging demonstrated resolution of the previously identified mass. <br> <br>The patient was permitted to gradually return to dance activities with guidance from Physical Therapy.

Author's Comments:
Elastofibroma dorsi is a benign soft tissue pseudotumor that most commonly occurs in the infrascapular region deep to the inferior scapula. It typically appears on imaging as a poorly defined, heterogeneous soft tissue lesion with characteristic interspersed fatty streaks.1-3 Elastofibroma dorsi is more common in females, with an approximate 3:1 female predominance, and most frequently presents during the fifth and sixth decades of life.2-3 <br>Although many lesions are discovered incidentally and remain asymptomatic, patients may present with periscapular pain, snapping, clicking, or a sensation of scapular clunking during shoulder movement.2-3 Once identified, asymptomatic lesions are typically managed with observation, while surgical excision is generally reserved for symptomatic patients with persistent pain or mechanical symptoms.2-3 <br> <br>This case is notable because the patient was substantially younger than the typical age at presentation and because both her symptoms and imaging findings resolved following nonoperative treatment consisting of osteopathic manipulative treatment and physical therapy. Given the rarity of spontaneous regression reported in the literature, this case highlights an unusual clinical course and underscores the importance of correlating imaging findings with symptoms when evaluating patients with periscapular pain.2-3

Editor's Comments:
Elastofibroma dorsi is an uncommon benign soft tissue pseudotumor that may present with periscapular pain, scapular snapping, or mechanical shoulder symptoms, but it is also frequently discovered incidentally on imaging.1-3 This case highlights the importance of pursuing additional evaluation when symptoms persist despite a reassuring shoulder workup, as the initial shoulder magnetic resonance imaging did not identify the eventual lesion. <br> <br>Although characteristic imaging findings can establish the diagnosis, clinicians should be cautious in attributing symptoms solely to the presence of an elastofibroma dorsi, as more common causes of shoulder pain and dysfunction may coexist. Elastofibroma dorsi is reported to be bilateral in a substantial proportion of cases, and spontaneous regression is rarely described.1-3 Ultrasound may also be a useful adjunctive imaging modality for evaluating superficial periscapular soft tissue lesions and correlating imaging findings with symptoms.1

References:
1. Radswiki T, Ibrahim D, Wilczek M, et al. Elastofibroma dorsi. Reference article, Radiopaedia.org (Accessed on 31 Mar 2026) https://doi.org/10.53347/rID-12565 <br> <br>2. Chandrasekar CR, Grimer RJ, Carter SR, et al. Elastofibroma dorsi: an uncommon benign pseudotumour. Sarcoma. 2008;2008:756565. doi:10.1155/2008/756565 <br> <br>3. Nishio J, Iwasaki H, Naito M. Current update on the diagnosis, management and pathogenesis of elastofibroma dorsi. Anticancer Res. 2021;41(5):2211-2218.

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