Fibromatosis colli

Infant with
torticollis and a right superior chest wall massAxial CT with contrast of the chest (above) shows asymmetry of the sternocleidomastoid muscles, right larger than left. Transverse US of the chest (middle) at the same level of the CT better shows the enlarged right sternocleidomastoid muscle. Sagittal US of the sternocleidomastoid muscles (bottom) shows the normal smooth contour of the left sternocleidomastoid muscle and the spindle shaped appearance of the right sternocleidomastoid muscle.The diagnosis was fibromatosis colli.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant with
torticollis since birth and a right neck massTransverse US of the neck shows a normal sized hyopechoic left sternocleidomastoid muscle lying above the jugular vein and carotid artery. The right sternocleidomastoid muscle is more heterogenous in echotexture and is 3-4 times larger in size than the left.The diagnosis was fibromatosis colli.
pediatricimaging.org • CC-by-nc-sa 4.0
A rare cause
of neck mass and torticollis in neonates. Longitudinal USG images of the neck shows normal sternocleidomastoid muscle on left side
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A rare cause
of neck mass and torticollis in neonates. Longitudinal USG of the neck shows a fusiform enlarged sternocleidomastoid muscle with heterogenous echotexture
www.eurorad.org • CC by-nc-sa-4.0
Infant with
torticollis since birth and a left neck massTransverse US of the neck shows a normal sized hypoechoic right sternocleidomastoid muscle lying above the jugular vein and carotid artery. The left sternocleidomastoid muscle has a heterogenous echotexture and is 5-6 times larger in size than the right.The diagnosis was fibromatosis colli.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Fibromatosis colli is a rare form of infantile fibromatosis that occurs within the sternocleidomastoid muscle.

Epidemiology

There may be a slight male predilection. It typically presents a few weeks after birth.

Clinical presentation

Presentation is usually with torticollis and is most frequently related to birth trauma (e.g. forceps delivery and difficult labor) or malposition (e.g. breech) in the womb. On clinical examination, there may be a growing, hard neck mass .

Pathology

The importance of fibromatosis colli, above all else, is that it must be recognized for the benign lesion that it is. It is unilateral in most cases. It has been proposed that birth trauma leading to hemorrhage as a predisposing factor eventually results in fibrosis.

Radiographic features

The right sternocleidomastoid muscle is more commonly affected (73% of the time).

Ultrasound

Ultrasound is the imaging modality of choice. The sternocleidomastoid muscle is diffusely enlarged (but most involves the muscle belly) to assume a fusiform/ellipsoid shape/thickening with resultant shortening, therefore the chin is turned away from the affected side (the mastoid process is drawn inferiorly towards the ipsilateral head of clavicle). Echogenicity may vary in the affected fibrotic regions. Spectral Doppler interrogation may reveal a high resistance waveform. The enlarged area often moves synchronously with the rest of the sternocleidomastoid on real-time sonography , smoothly blending with the unaffected fibers. A discrete mass should not be seen. The presence of hyperechoic calcific foci suggests previous hemorrhage.

CT

Typically shows a diffusely enlarged sternocleidomastoid that is isoattenuating to normal neighboring musculature. Adjacent fat planes are well preserved. At times, calcification may be present .

Treatment and prognosis

It is a self-limiting condition and usually resolves within 4-8 months  and requires no more than physiotherapy.

Differential diagnosis

For a general differential see: differential diagnosis of pediatric cervical lesions.

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Fibromatosis colli:
Elastofibroma
dorsi
Wikipedia • CC BY-SA 3.0
fibromatosis
 
Wikipedia • CC BY-SA 3.0
musculoskeletal
fibromatoses
Wikipedia • CC BY-SA 3.0
Musculus
sternocleidomastoideus
Wikipedia • Public domain
Bezoldscher
Senkungsabszess
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