Elastofibroma Dorsi: Findings on ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography

A 48-year-old woman underwent staging ¹⁸F fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F FDG PET-CT) for the evaluation of the left breast lesion. PET-CT revealed an FDG avid lesion in the left breast lower outer quadrant [Figure 1a and f] with few ipsilateral Level I and II lymph nodes showing increased FDG uptake [Figure 1a and g]. In addition to these findings, maximum intensity projection images of ¹⁸F FDG PET-CT showed symmetrical foci of FDG uptake in the bilateral posterolateral chest regions [Figure 1a black solid arrows]. Axial CT images [Figure 1b and d solid white arrows] show soft-tissue masses in the bilateral infrascapular locations which showed moderately increased FDG uptake in the fused PET-CT images [Figure 1c and e solid white arrows]. Biopsy from the left breast lesion showed invasive ductal carcinoma.

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Figure 1 (a) ¹⁸F fluorodeoxyglucose positron emission tomography-computed tomography maximum intensity projection image showing areas of moderately increased symmetrical fluorodeoxyglucose uptake in the bilateral lower chest regions shown by solid black arrows (b and d): Axial computed tomography images showing soft tissue masses in the bilateral subscapular regions which show moderate fluorodeoxyglucose uptake in the fused transaxial ¹⁸F fluorodeoxyglucose positron emission tomography-computed tomography images (solid white arrows) as seen in c, e and f - Fused transaxial fluorodeoxyglucose positron emission tomography-computed tomography image showing fluorodeoxyglucose avid lesion in the left breast parenchyma (g) - Fused transaxial fluorodeoxyglucose positron emission tomography-computed tomography image showing fluorodeoxyglucose avid left axillary lymph nodes

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Elastofibroma is a benign poorly circumscribed soft-tissue lesion classically located in the subscapular region and hence it is named as elastofibroma dorsi (EFD). It can be seen in other rare sites such as olecranon, ischial tuberosity, thighs, and subcutaneous tissue.[123] EFDs show diffuse low-to-moderate grade FDG uptake in a ¹⁸F FDG PET-CT scan although high FDG uptake can also be seen that may be caused due to high vascularity and abnormal fibroblastic reactive proliferation within the mass.[456] The correct diagnosis of this benign entity is essential to avoid any false positive results and unnecessary interventions in patients suffering from malignant conditions.