0:01

<v ->The the second case I will show you now

0:11

is another patient with trochanteric pain.

0:21

It's a 65-year-old woman

0:24

with chronic trochanteric pain

0:26

and no other clinical findings.

0:30

These are the images,

0:31

and I'd like you to see it before my comments.

0:52

I will show you the (indistinct).

1:11

Going back, what we see,

1:15

it's an ill-defined mass

1:19

between the iliotibial band and the greater trochanter.

1:28

This lesion has fats and fibrous tissues.

1:35

We can see a small amount of fluid here

1:39

that could be adventitious bursa

1:43

or the greater trochanter bursa.

1:47

I prefer to believe that the adventitious bursa.

1:52

Anyway,

1:57

if you pay attention in the images,

2:03

you see a similar mass

2:06

in the ischiofemoral space.

2:10

There are other findings like tendinopathy

2:12

and partial tear of the gluteus and hamstring tendons,

2:16

but I'm not worried about.

2:19

So we are talking about these two masses.

2:29

And if we think that there is fat

2:34

and fibrous tissue in a mass

2:37

in a place we have friction and impingement,

2:42

we should think about elastofibroma.

2:47

It's usually more common,

2:51

at least in the inferior angle of the scapula,

2:55

but it could be any place of the body

2:58

that we have this characteristic friction and impingement;

3:03

usually it's bilateral.

3:05

And it can appear in more than one place

3:09

in people that have one of these lesions.

3:15

It's a benign fibroblast or myofibroblast tumor.

3:19

Usually it's symptomatic, slow growing,

3:24

solid, hard mass, fixed to the deep plains.

3:30

And, in this case specifically, they took it out.

3:36

They made the resection 'cause the patient had lots of pain,

3:39

and it was really an elastofibroma.

3:43

Don, that's the end of this case.

3:48

And I'd like to ask you

3:50

if you think this is adventitious bursitis

3:55

or is it greater trochanter bursitis?

3:59

<v ->This is a very interesting case.

4:04

You know, one of my job for many years

4:07

was to come up with cases for the quiz panel

4:09

of the International Skills Society.

4:12

And, as I look at this case,

4:14

I think this would be a terrific case.

4:18

Let me ask first that, when they removed it,

4:21

was there a bursal lining that they commented on

4:24

or was it all just elastofibroma?

4:29

<v ->It was great elastofibroma.

4:33

<v ->Okay, because I certainly am familiar with elastofibromas.

4:39

I am not familiar with one in this location.

4:42

And just as you suggested,

4:45

most of the cases I have seen have been deep to the scapula

4:50

often in young, often in women who are very thin,

4:54

sometimes in active women.

4:56

The last two that I saw were in baseball pitchers,

5:01

on the dominant side,

5:03

related to friction between the ribs and the scapula.

5:07

But I have never seen a case of elastofibroma here.

5:13

And I think it's a wonderful case.

5:16

I certainly am glad I didn't have to diagnose it.

5:20

What was your differential?

5:22

I mean, when you saw this, what was your first choice?

5:27

<v ->We just thought elastofibroma.

5:31

And you don't know that I found another one two weeks ago.

5:34

We had another case two weeks ago.

5:36

It's bilateral

5:38

<v ->In this location.

5:41

<v ->Exactly the same aspect.

5:44

<v ->It's interesting because,

5:47

as I talked about the iliotibial tract,

5:51

there is the theory that it's related to changes in fat

5:55

rather than a true bursitis.

5:57

I think you should, and I'll be glad to help you,

6:01

but you should collect and report them

6:04

because I think this is a very interesting observation.

6:10

Do you know if there are cases of that

6:12

reported in the literature here at this location?

6:16

<v ->I'm quite sure there is.

6:19

I think I have a (indistinct).

6:23

I'll see and I'll send you.

6:26

I'm not quite sure.

6:27

<v ->Let's make contact after the conference

6:30

and see if we can write these up, okay?

6:32

<v ->Okay.

6:34

I have two cases.

6:35

<v ->Okay. That's good.