초록접수 현황
| 15F-243 | 포스터 발표 |
Concomitant Surgical Approach for Bilateral Elastofibroma Dorsi in Prone Position
안세하, 김경수, 문석환
가톨릭대학교 의과대학 서울성모병원 흉부외과학교실
Background : Elastofibroma dorsi (EFD) is rare, benign, soft tissue tumor. Most cases are unilateral that bilateral cases are more rarely reported. The etiology of EFD is not well established but continued mechanical friction may cause the reactive hyperproliferation of fibroblastic tissue. Total surgical excision is recommended under following circumstances: a functional disability, compression symptoms, causing pain, morphologically disfiguring, swelling in the chest wall or when the mass of thorax exceeds 5 cm in diameter. We present a rare case of bilateral EFD which was successfully resected via concomitant bilateral approach in prone position.
Methods : A 54 years old male patient complained of lump in both sides of chest walls which had slowly been growing for a year before his admission to the hospital. Physical examination revealed two separate immobile, painless, firm, palpable mass measuring approximately 9.0 x 2.0 cm on each sides of subscapular areas. Chest computed tomography (CT) and chest magnetic resonance imaging (MRI) revealed symmetric soft tissue density mass, suggestive bilateral EFD (Fig. A and B). Under the general anesthesia, the patient was placed in prone position for bilateral simultaneous approach (Fig. C). The skin incision was made bilaterally along the scapular border in curvier shape. The ovoid, large mass was palpated that dissection was extended upward to the 4th ICS and downward to the 7th ICS. The mass was resected from subscapular muscle, rhomboids muscle with avoiding vessel or nerve injury (Fig. D).
Results : Bilateral mass were totally excised and the frozen results revealed as benign with intact margin. The final pathologic finding was compatible with EFD. Examination of the gross specimen revealed gray colored, rubbery mass measuring 11.5 x 8.5 x 2.5 cm in left side and 13.5 x 10.0 x 3.8 in right side. The operation time took 179 minutes and the patient was discharged 5 days after the operation without complications such as paralysis and restricted ROM.
Conclusion : In our case, the prone position was very useful, not only because the lesions were bilateral but also in order to shorten the operation time by skipping the step of positional change with achieving the proper abduction of the both arms to elevated the scapula and with widening the thoracic cage. In summary, we successfully resected a rare case of bilateral EFD through the concomitant surgical approach in prone position.
Methods : A 54 years old male patient complained of lump in both sides of chest walls which had slowly been growing for a year before his admission to the hospital. Physical examination revealed two separate immobile, painless, firm, palpable mass measuring approximately 9.0 x 2.0 cm on each sides of subscapular areas. Chest computed tomography (CT) and chest magnetic resonance imaging (MRI) revealed symmetric soft tissue density mass, suggestive bilateral EFD (Fig. A and B). Under the general anesthesia, the patient was placed in prone position for bilateral simultaneous approach (Fig. C). The skin incision was made bilaterally along the scapular border in curvier shape. The ovoid, large mass was palpated that dissection was extended upward to the 4th ICS and downward to the 7th ICS. The mass was resected from subscapular muscle, rhomboids muscle with avoiding vessel or nerve injury (Fig. D).
Results : Bilateral mass were totally excised and the frozen results revealed as benign with intact margin. The final pathologic finding was compatible with EFD. Examination of the gross specimen revealed gray colored, rubbery mass measuring 11.5 x 8.5 x 2.5 cm in left side and 13.5 x 10.0 x 3.8 in right side. The operation time took 179 minutes and the patient was discharged 5 days after the operation without complications such as paralysis and restricted ROM.
Conclusion : In our case, the prone position was very useful, not only because the lesions were bilateral but also in order to shorten the operation time by skipping the step of positional change with achieving the proper abduction of the both arms to elevated the scapula and with widening the thoracic cage. In summary, we successfully resected a rare case of bilateral EFD through the concomitant surgical approach in prone position.
책임저자: 문석환
가톨릭대학교 의과대학 서울성모병원 흉부외과학교실
연락처 : 안세하, Tel: 02-2258-6139 , E-mail : cskks@catholic.ac.kr
