A 75-year-old male patient came to the outpatient surgery department at Pravara Rural Hospital in Loni complaining of a 5-year-old swelling that had been gradually getting worse over the left upper back and shoulder region. History showed that the swelling was approximately 1 cm in size when he first noticed it a few months ago but gradually grew in size until it reached a large one. For six months, he also experienced discharge from the swelling.

An extensive multi-lobulated soft cystic swelling measuring 20 cm by 17 cm by 10 cm was found during a clinical examination of the swelling over the left upper back and shoulder (Figure 1). There was a cream-coloured discharge that had the consistency of butter and was oozing from the swollen punctum.

The patient’s ultrasound results showed a large, well-defined, lobulated, heterogeneous hypoechoic lesion with numerous small calcifications on the left upper back region (Figure 2). The Doppler study revealed no internal vascularity or a solid component within the swelling’s underlying aetiology. In the subcutaneous plane of the cervical region and upper back region on the left side, there was a multi-lobulated area of altered signal intensity that measured roughly 8.5 10.4 14.8 cm (AP TR CC), appeared hyperintense on T2W and STIR images, and appeared hyperintense on T1W images. DWI showed diffusion restrictions in these regions. Indistinct fat planes with the trapezius are visible anteriorly. The trapezius was displaced laterally, anteriorly, and posteriorly over the skin as a result of this lesion. A thin peripheral enhancement was discovered during the post-contrast study. Fat in the vicinity seems normal. Findings that could point to sebaceous cysts.