Chest wall primary tumors include a broad spectrum of benign and malignant tumors. Tumor biopsy is essential to set diagnosis. This rule does not apply to the elastofibroma dorsi. Elstofibroma is an unusual, well defined tumor of soft tissues typically located in the peri-scapular region, composed of characteristic abnormal elastinophilic fibers and adipose tissue. It affects mainly elderly people and especially women. In magnetic resonance imaging and computed tomography elastofibroma presents a characteristic layered pattern of fatty and fibrous tissue. The typical location and the characteristic imaging pattern set the diagnosis of elastofibroma without the need for biopsy. Biopsy is required in atypical cases to exclude malignancy, especially sarcoma. In asymptomatic cases, simple monitoring is sufficient. Surgical excision is recommended for serious symptoms and diagnostic doubt. The prognosis is excellent. No case of malignant transformation has been described.
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