Incidental elastofibroma dorsi on chest computed tomography scan: A cross-sectional study of prevalence and diagnostic oversight among radiologists

Elastofibroma dorsi is a rare, benign fibroelastic tumor primarily affecting the subscapular region. Despite its characteristic imaging features, misdiagnosis is common, usually leading to unnecessary interventions. This study aims to assess the prevalence of elastofibroma dorsi among computed tomography (CT) scans of 2000 patients, to analyze the demographic and clinical characteristics of the patients and assess radiologists' diagnostic accuracy regarding this condition. In this cross-sectional study a total of 2000 CT scans were retrospectively reviewed, scans positive for elastofibroma dorsi were then further analyzed for demographic and clinical features, including age, sex, comorbidities and lesions laterality. Additionally, 168 radiologists were assessed for their ability to accurately diagnose elastofibroma dorsi. A total of 45 patients has elastofibroma dorsi, representing a prevalence of 2.25%. The mean age of elastofibroma-patients was 73.49 ± 10.52 years, with a nearly equal sex distribution (48.89% male, 51.11% female). The most common disease or indication for the assessed CT images was malignancy (51.11%). Right sided involvement was predominant (86.67% of patients had right sided involvement whether alone or as part of bilateral involvement). Bilateral cases were 44.44%. Among the 168 radiologists, only 11.90% correctly identified elastofibroma dorsi on imaging. The most frequent misdiagnoses were mass or tumor (42.27%) and muscle (26.19%). Despite its distinct imaging characteristics, elastofibroma dorsi is frequently misdiagnosed, highlighting the need for increased awareness among radiologists. Due to its prevalence in elderly patients, elastofibroma dorsi should be included in the differential diagnosis of subscapular lesions to avoid misdiagnosis and unnecessary interventions.