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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 5  |  Issue : 4  |  Page : 271-273

Fibromatosis colli in neonates: An ultrasound study of four cases


Department of Radiodiagnosis and Imaging, Tapadia Diagnostic Centre, Aurangabad, Maharashtra, India

Date of Web Publication16-Nov-2016

Correspondence Address:
Dr. Mohammed Ashfaque Tinmaswala
Department of Radiology, Tapadia Diagnostic Centre, Aurangabad, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4847.194176

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  Abstract 

Fibromatosis colli is a benign swelling involving sternocleidomastoid muscle. It is usually seen in neonatal age group. The history of prolonged labor or difficult delivery may be present in many cases. The presentation usually is asymptomatic neck swelling or mass in neonates. In some cases, torticollis may be present. The diagnosis is usually done by ultrasound which may typically show fusiform and thickened sternocleidomastoid muscle on the affected side. We hereby report four cases of fibromatosis colli presenting in the neonatal period. All of them presented with neck swelling and were diagnosed to be having fibromatosis colli on ultrasound.

Keywords: Fibromatosis colli in neonates, sternocleidomastoid muscle, torticollis, ultrasound of neck


How to cite this article:
Kulkarni AR, Tinmaswala MA, Shetkar SV. Fibromatosis colli in neonates: An ultrasound study of four cases. J Clin Neonatol 2016;5:271-3

How to cite this URL:
Kulkarni AR, Tinmaswala MA, Shetkar SV. Fibromatosis colli in neonates: An ultrasound study of four cases. J Clin Neonatol [serial online] 2016 [cited 2019 Dec 15];5:271-3. Available from: http://www.jcnonweb.com/text.asp?2016/5/4/271/194176


  Introduction Top


Fibromatosis colli is an uncommon benign swelling caused by fibrous tissue proliferation within sternocleidomastoid muscle causing diffuse enlargement of sternocleidomastoid muscle. It is present in <0.5% of live births. The swelling is usually noticed within neonatal period.[1] Although fibromatosis colli is more common in neonates delivered by breech and difficult deliveries, especially those involving instrumentation it may also be seen in neonates delivered by uncomplicated normal vaginal deliveries.[2] It usually gets resolved on its own over a period of 4–8 months and usually does not require any treatment except for physiotherapy. Fibromatosis colli can be reliably diagnosed using ultrasound thereby ruling out the possibility of other more sinister neck swellings. Proper ultrasound diagnosis can avoid unnecessary investigations and potentially harmful therapeutic interventions.


  Case Reports Top


Case 1

A 2-week-old male child was brought to us for ultrasonography (USG) for the complaint of swelling on the right side of the neck. The baby was a full-term male child delivered by vaginal delivery. There was a history of assisted delivery in the form of forceps application. Baby cried immediately after birth, and there was no immediate postnatal complication. Mother noticed a swelling on the right side of neck and hence baby was referred for USG neck. On clinical examination, a firm and fusiform swelling of approximate size 2.5 cm × 3 cm was noted on the middle portion of the right sternocleidomastoid muscle. Ultrasound neck was done which showed a normal sized sternocleidomastoid on left side. On the right side, there was thickened and fusiform sternocleidomastoid with maintained fibrillar pattern of muscle fibers [Figure 1]. There was no evidence of hematoma or lymphadenopathy. Based on these ultrasound features, a diagnosis of fibromatosis colli was made.
Figure 1: Ultrasonography neck showing thickened and fusiform sternocleidomastoid characteristic of fibromatosis colli

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Case 2

A full-term male child delivered by uncomplicated normal vaginal delivery was referred to imaging department on D25 of life with the complaints of the baby not moving his head and keeping it in one posture and right sided swelling of the neck. On examination, there was a firm swelling on right side of neck clinically measuring approximately 3 cm × 2 cm. An ultrasound neck was done which showed features of fibromatosis colli (as described above) on the right side [Figure 2]. The sternocleidomastoid muscle on the left side was normal.
Figure 2: Normal sternocleidomastoid muscle (left side). Thickened sternocleidomastoid s/o fibromatoasis colli (right side)

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Case 3

A 3-week-old female child was brought with a complaint of asymptomatic swelling in neck noticed by mother. Antenatal and postnatal history was not significant. Natal history was significant as the baby was delivered by forceps secondary to prolonged labor. On examination, there was a firm swelling on left side of the neck in the mid portion of sternocleidomastoid muscle. It was fixed and nontender. USG of neck showed fusiform swelling of sternocleidomastoid muscle on left side confirming the diagnosis of fibromatosis colli [Figure 3]. The sternocleidomastoid on the right side was normal.
Figure 3: Ultrasonography neck showing fusiform and thickened sternocleidomastoid muscle s/o fibromatosis colli

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Case 4

20-day-old female child was referred for regional ultrasound in view of swelling in neck. Parents noticed the swelling on the left side of the neck when baby was 2-week-old. There was a history of prolonged and difficult labor and forceps application. Baby was afebrile and playful. On local examination, the swelling was nontender located over left sternocleidomastoid muscle. There was no evidence of erythema or raised temperature. There was restricted movement of the neck on affected side. On USG of neck there was evidence of fusiform swelling of sternocleidomastoid muscle on the left side while the sternocleidomastoid muscle on the right side was normal [Figure 4].
Figure 4: Grayscale ultrasound demonstrating fusiform thickening of sternocleidomastoid muscle

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  Discussion Top


The differential diagnosis for a child presenting with a neck swelling or mass can be diverse. These may include benign lesions such as cystic hygroma, thyroglossal cyst, arteriovenous malformations, lymphadenopathy, hemangioma, teratoma, and neurofibroma or malignant one like rhabdomyosarcoma, neuroblastoma, and metastatic adenopathy. While some of these swellings such as thyroglossal cyst and cystic hygroma are seen in early neonatal period others are usually seen after neonatal period. Nevertheless, all these conditions should be considered as differential diagnosis in children of any age group presenting with neck swelling or mass.[3]

Nothing relieves the parents more than informing them that the “tumour” their child having is benign or self-limiting. Fibromatosis colli is one such condition which usually presents in neonatal age group with swelling in neck with or without torticollis. The exact cause of this swelling is uncertain, but birth trauma, or intrauterine position of the baby is thought to be important etiological factors. One interesting study has reported that magnetic resonance imaging (MRI) done in these patients showed signals in the sternocleidomastoid muscle similar to those observed in the forearm and leg after compartment syndrome postulating that congenital affection of sternocleidomastoid muscle may actually be the sequelae of an intrauterine or perinatal compartment syndrome.[4]

The diagnosis of fibromatosis colli can be done by ultrasound of neck which usually shows spindle shape or fusiform thickening of sternocleidomastoid muscle. Sometimes, it is surrounded by a focal hypoechoic rim representing compressed normal muscle. It is important that the finding be compared with the normal sternocleidomastoid muscle on contralateral side. USG moreover can simultaneously rule out other pathologies like lymphadenopathy or cystic lesion like cystic hygroma. Torticollis may be present in 20% of the patients with fibromatosis colli.[5] On computed tomography (CT) fibromatosis colli can present as isodense diffuse enlargement of sternocleidomastoid muscle [6] but CT involves exposure to radiation. MRI if done may show the signal intensity of the mass on T2-weighted images to be slightly less than on gradient-recalled T1-weighted images which is consistent with the presence of fibrous tissue within the muscle mass.[7] The morphology of affected sternocleidomastoid can be better appreciated on MRI, but MRI needs a cooperative child. Moreover, a cooperative child itself is a rare entity! Hence, CT involving radiation and MRI requiring a cooperative child brings into significance the option of using ultrasound as the desired modality to diagnose fibromatosis colli. In the presence of typical ultrasound features fine needle aspiration cytology and histopathology is not required but if done may reveal atrophy of skeletal muscle fibers and regenerating muscle giant cells.[8] Since it is a self-limiting condition reassurance of parents, observation and physiotherapy is all that is required.[9] It is expected to resolve on its own over a period of 4–8 months.[10]


  Conclusion Top


A sound knowledge of ultrasound features of fibromatosis colli may obviate the need for relatively unsafe and invasive diagnostic procedures. The value of ultrasound in diagnosing this condition and thereby preventing further unnecessary investigations and uncalled for therapeutic interventions cannot be overemphasized.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ling CM, Low YS. Sternomastoid tumor and muscular torticollis. Clin Orthop Relat Res 1972;86:144-50.  Back to cited text no. 1
    
2.
Nilesh K, Mukherji S. Congenital muscular torticollis. Ann Maxillofac Surg 2013;3:198-200.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Guarisco JL. Congenital head and neck masses in infants and children. Part II. Ear Nose Throat J 1991;70:75-82.  Back to cited text no. 3
    
4.
Davids JR, Wenger DR, Mubarak SJ. Congenital muscular torticollis: Sequela of intrauterine or perinatal compartment syndrome. J Pediatr Orthop 1993;13:141-7.  Back to cited text no. 4
    
5.
Schneble F. Fibromatosis colli – Sternocleidomastoid pseudotumor of infancy. Pediatr Radiol 2016;5:3.  Back to cited text no. 5
    
6.
Crawford SC, Harnsberger HR, Johnson L, Aoki JR, Giley J. Fibromatosis colli of infancy: CT and sonographic findings. AJR Am J Roentgenol 1988;151:1183-4.  Back to cited text no. 6
    
7.
Ablin DS, Jain K, Howell L, West DC. Ultrasound and MR imaging of fibromatosis colli (sternomastoid tumor of infancy). Pediatr Radiol 1998;28:230-3.  Back to cited text no. 7
    
8.
Rajalakshmi V, Selvambigai G, Jaiganesh. Cytomorphology of fibromatosis colli. J Cytol 2009;26:41-2.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Lowry KC, Estroff JA, Rahbar R. The presentation and management of fibromatosis colli. Ear Nose Throat J 2010;89:E4-8.  Back to cited text no. 9
    
10.
Macdonald D. Sternomastoid tumour and muscular torticollis. J Bone Joint Surg Br 1969;51:432-43.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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