Surgical Management of Symptomatic Bilateral Elastofibroma Dorsi: A Case Report and Literature Review

BACKGROUND Elastofibroma dorsi (ED) is a rare, benign, slow-growing soft tissue pseudotumor typically located beneath the scapula. It predominantly affects older adults and shows a higher prevalence among women, usually in the infrascapular region. Lesions may occur unilaterally or bilaterally. While most cases remain asymptomatic, symptomatic patients may present with pain, swelling, or functional discomfort. CASE REPORT We report the case of a 46-year-old man with a history of abdominoplasty and sleeve gastrectomy who presented with a swelling on the left upper back persisting for more than 1 year. The swelling was initially painless but became painful during the preceding 4 months. He also reported intermittent swelling on the right side, without constitutional symptoms. Physical examination revealed a hard, immobile mass at the lower pole of the left scapula, while the right-sided mass became evident during abduction. Magnetic resonance imaging (MRI) demonstrated bilateral ill-defined lesions in the subscapular and infrascapular regions, measuring 13×3.5×8.5 cm on the right and 10×3×8 cm on the left, with heterogeneous signals and modest post-contrast enhancement, suggestive of elastofibroma. The patient underwent successful bilateral complete excision under general anesthesia through posterolateral subscapular incisions. Postoperative recovery was uneventful, with complete resolution of pain and functional symptoms within 1 week. CONCLUSIONS This case emphasizes how crucial it is to get a complete medical history and perform a physical examination. Characteristic MRI results can help avoid needless biopsies or operations. However, surgical excision is regarded as curative if clinically indicated.