Operative Management in a Patient with Scapulothoracic Bursitis
A 58-year-old male patient presented with a rapidly growing mass at the right posterior chest wall for one month. Initially, the patient had found an egg-sized lump at his right posterior chest wall. The patient received acupuncture at an oriental medicine clinic 10 days before admission. The soft mass showed relative hardening and rapid growth after the acupuncture.\nIn the physical examination, an approximately 5-cm mass was palpable at the right posterior lateral chest wall around the inferior angle of the scapula. The mass was mild and tender, without heat or redness. The patient had no history of trauma and had played golf excessively for the last six months.\nChest radiograph showed no bony abnormality or lung infiltration. Chest computed tomography showed a heterogeneous cystic mass on the right chest wall. A magnetic resonance axial T1-weighted image showed a well-demarcated lenticular mass lesion located in the right subscapular region between the serratus anterior muscle and the thoracic rib cage ().\nWe first recommended sonographically guided aspiration; however, the patient refused to undergo this procedure because of the possibility of recurrence after aspiration and rapid growth of mass. Excision of the mass was performed under general anesthesia. The patient was placed in a left lateral decubitus position. The latissimus dorsi and serratus anterior muscle were dissected after an incision was made over the right subscapular area. A soft, movable scapulothoracic mass, which was loosely attached between the serratus anterior and the intercostal muscle, was observed.\nA well-encapsulated cystic mass measuring 8×5×5 cm in size was excised. A hemorrhage occurred, which was suspected to be a result of acupuncture in an oriental medicine clinic (). A histopathologic examination showed a pseudocyst with a thickened fibrotic wall, which was filled with blood clots. Many lymphocyte proliferations were observed in the cystic wall without neoplastic cells ().\nThis patient's history included playing golf, pathological features, and radiological images; therefore, this patient was diagnosed with scapulothoracic bursitis. The patient recovered well after surgery. No chest wall pain was observed, and no recurrent mass was found at the 10-month follow-up. The patient still enjoys playing golf.