Elastofibroma dorsi: imaging-guided minimally invasive treatment using percutaneous CO₂ cryoablation

Elastofibroma dorsi is a benign slow-growing fibroelastic pseudotumoral lesion that typically arises in the infrascapular region of elderly individuals and is usually managed conservatively or by surgical excision when symptomatic. Percutaneous cryoablation has only recently been described for this entity, and experience remains very limited. We report the case of a symptomatic left elastofibroma dorsi treated by percutaneous cryoablation using a CO₂-based system.

A 66-year-old man with non-painful but mechanically symptomatic left elastofibroma dorsi, unwilling to undergo surgery, came to our attention to be treated with minimally invasive approach. Pre-treatment MRI demonstrated a lesion measuring 48 × 18 × 70 mm (31.6 mL) in the typical subscapular location. The lesion was treated by US-CT-guided percutaneous cryoablation using a CO₂-based system (Metrum Cryoflex, Lomianki, Poland) equipped with a 4.5 cm of exposed tip cryoapplicator.

The procedure was technically successful and well tolerated, with no immediate or delayed complications and free from immediate and post-treatment pain. At 3-month follow-up, contrast-enhanced MRI showed size reduction to 38 × 12 × 59 mm (14.1 mL, - 55.3% volume reduction), with internal non-enhancing necrotic change consistent with post-ablation effect. Clinically, the patient reported complete resolution of mechanical symptoms.

This case suggests that percutaneous CO₂ cryoablation may represent a feasible minimally invasive treatment option for selected patients with symptomatic elastofibroma dorsi. The use of a CO₂-based cryoablation platform may offer practical and economic advantages, although its lower freezing capacity compared with conventional argon-and nitrogen-based systems requires careful procedural planning.