PMC9979910_01
Picture of the Right posterior thorax. Visualization of the mass was possible from neutral positioning.
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It was visible in the neutral position, localized just inferior to the right scapula, nontender to palpation and nonmobile (Figure 1).
POCUS at initial office visit of the right posterior thorax below the scapula. Images include proximal long right lateral orientation just below the shoulder blade showcasing heterogeneous soft tissue mass located deep to the superficial musculature.
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The mass was heterogeneous, nonencapsulated with similar echogenicity to subcutaneous fat and interweaving hypoechoic regions indicating a possible inflammatory response with fluid buildup (Figure 2).
FormalUltrasound. Posterior right chest along the inferior aspect of the scapula superficial to the scapula and along the chest wall, a 4.8 x 4.1 x 1.9 cm heterogeneous soft tissue mass without significant flow seen on color Doppler imaging. It is located deep to the superficial musculature. Initial impression of a complex nonspecific soft tissue mass reflecting swelling from surgery or an injury. Neoplasm was not excluded.
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A formal ultrasound of the mass and chest Xray were ordered after the initial visit (Figure 3).
MRI of the Scapula. Mass deep to the right latissimus dorsi and serratus anterior muscles at and extending inferior to the distal tip of the scapula. This measures 6.9 x 1.5 cm, composed of soft tissue components of similar signal intensity in the skeletal muscle with small foci of intermixed fat and mild heterogeneous postcontrast enhancement. Impression of the exam was consistent with elastofibroma dorsi. [A:Anterior, S: Superior].
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An MRI was subsequently ordered and resulted in the diagnosis of ED (Figure 4.) The patient continued to have significant discomfort, thus surgical referral was placed for possible resection. 
Example of benign lipoma with sonographic appearance of well organized, heterogeneous echogenicity with multiple clearly defined long smooth continuous internal echogenic lines parallel to the long axis of the lesion superficial to any musculature.
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Figure 5 can be referenced as an example of a benign soft tissue mass for comparison.