Tatiane Cantarelli just shared these companion cases and comments
(I have never reported elastofibroma in the subacromial region…perhaps I have missed it)
Hi Hilary,
I wanted to share one more case with you.This patient has bilateral peritrochanteric elastofibroma, but only has mild bursitis on the right side, which is where he reported pain.
Interestingly, the same patient also has a subacromial elastofibroma without significant bursitis.
We rarely see isolated scapulothoracic bursitis in general. I’ve also encountered cases of ischiofemoral elastofibroma without any associated bursitis. It seems that trochanteric bursitis might be more commonly associated with elastofibroma, possibly because trochanteric bursitis occurs in isolation more frequently (???). Maybe… i don’t know.
Tatiane
Tatiane Cantarelli
Em seg., 22 de jul. de 2024 às 09:14, hilary umans <hilary.umans> escreveu:
I received a handful of comments….I suspect most of you wrote this off as bursitis and couldn’t imagine what I was thinking in posting this case.
Drs. Mario Maas and Filip Vanhoenecker had previously seen cases of peritrochanteric elastofibroma dorsi in the hip and are quite convinced this is the proper diagnosis.
I discussed this case with my colleague who shared it with me just yesterday—the original body CT I posted was from Dec 2022….I understand the patient had a more recent outside CT which might have only included the left hip. I suspect they didn’t have the prior CT to compare, and they were concerned about the peritrochanteric mass, prompting the current hip MRI.
The soft tissue thickening with fat infiltration and stranding…which we know to be bilateral, really does look more like reported cases of elastofibroma.
BUT there seems to be superimposed severe trochanteric bursitis.
My colleague and I agreed that there are elements of both elastofibroma and bursitis in this case….and suspect that the bursitis is reactive to the chronic friction and mechanical irritation by the adjacent peritrochanteric mass.
So that begs the obvious question….if elastofibroma forms as a result of chronic repetitive friction, why don’t we commonly see scapulothoracic bursitis in conjunction with the more typical chest wall elastofibroma?
Hilary
CT was from 1.5 years ago done for an indication of unexplained weight loss
There is fibrofatty soft tissue thickening in the bilateral trochanteric region…not mentioned in the CT report…though the current referrer ordered MRI of the left hip only to evaluate a soft tissue mass in the left trochanteric region on previous CT. It is not clear if it is symptomatic.
My colleague asked me if this could be elastofibroma dorsi…I know there have been reports, though I have never made that diagnosis outside of the chest.
Had I read the hip MRI without the CT, I think I would have reported it as trochanteric bursitis….because there is rim enhancement and central fluid signal.
But there is measurable fat attenuation on CT and now I’m not so sure.
It’s really academic…it’s benign….I suspect the referrer is searching for neoplasm, which this is not.
I’m attaching 2 case reports Dr. Aquiar previously shared…one with CT only (looks like this), one with MRI….with diffuse enhancement and no central liquefaction.
CT was from 1.5 years ago done for an indication of unexplained weight loss
