Tietze's syndrome was initially described almost 100 years ago and is an inflammatory process affecting the costochondral cartilages [1] [2] [3]. The etiology and pathogenesis are yet to be elucidated but it is most frequently diagnosed in adults less than 40 years of age who suffer from numerous conditions of rheumatic and non-rheumatic origin [1] [2]. Rheumatoid arthritis (RA), seronegative spondyloarthropathies, trauma, various infections (tuberculosis, brucellosis) and malignant diseases (multiple myeloma, chondrosarcomas, local invasion of breast and lung tumors, but also metastatic dissemination) are mentioned as disorders that may cause Tietze's syndrome [1] [3] [4]. Although it is often mistaken with costochondritis, however, several well-established features distinguish the two clinical entities [4]. The clinical presentation of Tietze's syndrome is demarcated by swelling and tenderness of the costosternal, costochondral and/or sternoclavicular joints, suggesting that the upper ribs are more commonly affected, whereas the manubrium of the sternum and the xiphoid process are rarely involved [1] [2]. Costochondritis, on the other hand, develops in older adults (> 40 years of age) and without swelling of the adjacent tissues [4]. Moreover, only one costal cartilage exhibits inflammatory changes (either the third or second rib) in 80% of patients with Tietze's syndrome, while multiple sites are affected in more than 70% of patients suffering from costochondritis [2] [3] [4]. In addition, one of the most important features of Tietze's syndrome is pain at the site of inflammation, which is often aggravated by coughing, deep breathing or lying prone [1] [2] [4]. Although this syndrome is benign, a relapsing/remitting course is observed, as pain can disappear spontaneously and then reappear and be present for weeks or months, often followed by swelling [1].

• Relapsing Polychondritis

  It also can be caused by relapsing polychondritis. The pathogenesis underlying the development of costochondritis remains unclear. [en.wikipedia.org]

  polychondritis M94.20 …… unspecified site M94.21 Chondromalacia, shoulder M94.211 Chondromalacia, right shoulder M94.212 Chondromalacia, left shoulder M94.219 Chondromalacia, unspecified shoulder M94.22 Chondromalacia, elbow M94.221 Chondromalacia, right [icd10data.com]

• Chest Wall Pain

  Treatment of musculoskeletal chest pain. http://www.uptodate.com/home. Accessed Feb. 4, 2015. McMahon SB, et al. Thoracic pain. In: Wall & Melzack''s Textbook of Pain. 6 th ed. [mayoclinic.com]

• Sneezing

  In many cases, physical movements like excessive coughing, sneezing or vomiting causes Tietze syndrome that leads to chest pain. The syndrome is most common in teenagers and adults. [syndromespedia.com]

  Symptoms The pain associated with costochondritis usually: Occurs on the left side of your breastbone Is sharp, aching or pressure-like Affects more than one rib Can radiate to arms and shoulders Worsens when taking a deep breath, coughing, sneezing or [mayoclinic.org]

  The condition usually starts with an ache between the shoulder blades, possibly after a shower of sneezes or a chronic cough. Asthmatics are particularly prone, children too. Trauma to the ribcage is another cause. [news24.com]

  The pain may be made worse by: a particular posture, such as lying down pressure on your chest, such as wearing a seatbelt or hugging someone deep breathing, coughing and sneezing physical activity In cases of Tietze’s syndrome, there may also be some [healthinmotion.org.uk]

  Sneezing Straining Lying down on my back (I slept propped up with many pillows). Lying on my back forced pressure onto my breastbone. Anti-inflammatory drugs Cortisone shots into the cartilage can relive pain. 1-3 shots may be needed. [orthohyd.com]

• Pneumonia

  Musculoskeletal: Fibromyalgia Rib fracture Ankylosing spondylitis Bone metastasis from cancers such as prostate cancer, breast cancer, plasmacytoma, and sarcomas Reactive arthritis Psychogenic: Anxiety disorder Panic disorder Hyperventilation Respiratory: Pneumonia [en.wikipedia.org]

  Pneumonia with or without pleural effusion, usually presents with fever and tachypnea; chest pain may be presenting symptom sometimes. [doi.org]

  Pneumonia - cough, fever, chest signs. Pulmonary embolism (PE) - pleuritic pain, breathlessness, tachypnoea, reduced oxygen saturation on pulse oximetry. [patient.info]

  Chest pains can often mean that you’re having heart issues, so see your doctor right away when you feel pain in your chest to make sure that you’re not having a heart attack or have pneumonia. [healthline.com]

  […] sophisticated imaging study of the chest called a gallium scan, which will show increased uptake of the radioactive material gallium in an area of infection Check the white blood cell count to see if it is elevated, a sign of infection Order a chest X-ray if pneumonia [webmd.com]

• Rib Tenderness

  Symptoms include: a sharp pain in your upper ribs tenderness around the area of your upper ribs swelling around the area of your upper ribs Sudden movements of your ribs, during physical activity or when you cough or sneeze, may make the pain worse. [hse.ie]

  Palpation with anterior to posterior pressure up to the point of initiation of rib movement at the costosternal joints reproduced the subjects’ symptoms and demonstrated tenderness of at least two consecutive costosternal junctions from the second to [ncbi.nlm.nih.gov]

• Chest Wall Tenderness

  Coronary artery disease is present in 3 to 6 percent of adult patients with chest pain and chest wall tenderness to palpation. [ncbi.nlm.nih.gov]

• Chest Pain

  The condition is a common cause of chest pain. [en.wikipedia.org]

  Treatment of musculoskeletal chest pain. http://www.uptodate.com/home. Accessed Feb. 4, 2015. McMahon SB, et al. Thoracic pain. In: Wall & Melzack''s Textbook of Pain. 6 th ed. [mayoclinic.com]

• Hypertension

  Tietze syndrome is ... (41 of 736 words, 1 image ) en.wikipedia.org/wiki/Tietze syndrome American Heritage Dictionary: Collins Dictionary: syndrome | white-coat hypertension [medicine] any combination of signs and symptoms that are indicative of a particular [memidex.com]

  […] may present similarly to angina pectoris, normally associated with heart disease, and can cause hyperventilation, anxiety or panic attacks, syncope (passing out), and temporary hypoesthesia (numbness) paralysis, and due to pain high blood pressure or hypertension [en.wikipedia.org]

  Wrist Training Headache Hearing Heart Condition Heart Rate Heart Rate Monitor Hernia Hiking Hip Injury Hip Replacement Hip Training Hiring HIV/AIDS Holistic Health Hormones Horseback Riding Human Learning Hydration Hydrotherapy Hygiene Hyperglycemia Hypertension [ptonthenet.com]

  It can cause: Panic attacks Anxiety Hyperventilation Temporary hypoesthesia (numbness) paralysis Syncope (passing out) It can also cause pain due to hypertension or high blood pressure. [marijuanadoctors.com]

  Ramsaran EK, Benotti JR, Spodick DH (1995) Exacerbated tamponade: deterioration of cardiac function by lowering excessive arterial pressure in hypertensive cardiac tamponade. Cardiology 86:77–79 CrossRef PubMed Google Scholar 32. [doi.org]

• Localized Chest Pain

  Persistent chest pain of any type associated with nausea, sweating, left arm pain, or any generalized chest pain that is not well localized. [webmd.com]

• Joint Swelling

  Tietzes syndrome usually affects the third, fourth and fifth costochondral joint. The manubriosternal and xiphisternal joints are less frequently affected. Joint swelling distinguishes the condition from costochondritis. [physio-pedia.com]

The diagnosis of Tietze's syndrome may be difficult to make without a properly obtained patient history, which provides important clues regarding the onset and course of symptoms. Furthermore, swelling and pain can be assessed only if a thorough physical examination is performed, and the exact location of pain is identified during palpation of the chest wall. Tietze's syndrome is considered to be a diagnosis of exclusion, making imaging studies an essential component during workup [1]. Various techniques have been evaluated for their benefit in diagnosing Tietze's syndrome, including plain radiography, computed tomography (CT) and ultrasonography (US), all showing limited use [2] [3]. Magnetic resonance imaging (MRI) and bone scintigraphy, on the other hand, are currently recommended due to their ability to show inflammatory changes in the cartilage, and also because they are able to exclude other etiologies (tumors, abscesses, etc.) [2] [3]. Certain reports, however, suggest that a biopsy is the only reliable method to confirm the clinical suspicion of Tietze's syndrome, typically revealing nonspecific findings (increased vascularity, patchy loss of ground substance and degenerative changes) on histological examination [2] [5].

• Staphylococcus Aureus

  An English literature review of primary chest wall abscess showed that 4 pathogens are responsible for the majority of cases: Actinomyces, Staphylococcus aureus, Candida albicans and Salmonella. [ncbi.nlm.nih.gov]

  Most cases of infectious costochondritis are caused by Actinomyces, Staphylococcus aureus, Candida albicans, and Salmonella. In rare cases, Escherichia coli can be a cause of infectious costochondritis. [en.wikipedia.org]

Treatment focuses on pain relief. [mayoclinic.com]

The long-term prognosis is good. [ncbi.nlm.nih.gov]

Prognosis References Aeshilmann, A, Kahn MF (1990) Tietze's syndrome: a critical review. Clinical Experimental Rheumatology 8:407 Google Scholar Copyright information [link.springer.com]

What is the prognosis for costochondritis and Tietze syndrome? The outlook for costochondritis and Tietze syndrome is generally very good. Most patients respond well to conservative treatments. [medicinenet.com]

Treatment and prognosis It is a benign condition that may subside spontaneously. Some authors suggest local steroid injection as a possible treatment option 6. [radiopaedia.org]

The prognosis is good. Constant complaints are not expected. [memim.com]

Imaging studies, such as magnetic resonance imaging or computed tomography, are useful in excluding other etiologies or to confirm an ongoing inflammatory process in the chondrosternal joints. [symptoma.com]

Epidemiology Frequency United States The exact prevalence of a musculoskeletal etiology for chest pain is not known, although overall prevalence of a musculoskeletal etiology for chest pain was approximately 10% in one study. [emedicine.medscape.com]

Thoracic pain is an entity that can be difficult to diagnose etiologically. Once the cardiac origin has been ruled out, the rheumatologic, neoplastic, and infectious causes have to be taken into account. [ncbi.nlm.nih.gov]

In the majority of cases, the etiology of the chest pain is benign, but in one-fourth of the cases symptoms are distressing enough to cause children to miss school. [doi.org]

Etiology (causes) : Direct injury to the chest, viral infections (cold / flu), idiopathic (the cause cannot be found). Its clinical manifestations : Pain, tenderness in those joints I already mention earlier. [unboundedmedicine.com]

Epidemiology Frequency United States The exact prevalence of a musculoskeletal etiology for chest pain is not known, although overall prevalence of a musculoskeletal etiology for chest pain was approximately 10% in one study. [emedicine.medscape.com]

Epidemiology [ 1, 2 ] Chest pain accounts for 1-2% of consultations in primary care, in which setting a cardiac cause is significantly less likely than in presentations to emergency departments [ 3 ]. [patient.info]

These articulations are called the costovertebral joints. [11] Epidemiology /Etiology The etiology of Tietze syndrome is unknown but Tietze syndrome is often associated in acute cases associated with viral respiratory tract infections. [physio-pedia.com]

Thus, cervical or shoulder problems may refer pain to the chest wall. 2 Epidemiology Costochondritis can affect children as well as adults. [aafp.org]

It does not appear to be an inflammatory disorder, and although the pathophysiology is unkown, could result from injury to costosternal, sternoclavicular, or costochondral articulations from severe or protracted coughing. [link.springer.com]

Pathophysiology Costochondritis is an inflammatory process of the costochondral or costosternal joints that causes localized pain and tenderness. Any of the 7 costochondral junctions may be affected, and more than 1 site is affected in 90% of cases. [emedicine.medscape.com]

Is it possible to prevent costochondritis and Tietze syndrome? Costochondritis and Tietze syndrome cannot be prevented. Although aggravating the symptoms can be minimized by avoiding injury to the chest wall. [medicinenet.com]

Together, we’re preventing, diagnosing and treating diseases with greater precision — an approach we call The Keck Effect. [keckmedicalcenterofusc.org]

Develop a thorough, clinically relevant understanding of interventions such as physical agents and therapeutic exercise in the prevention, diagnosis, treatment, and rehabilitation of disorders that produce pain, impairment, and disability. [books.google.com]

Costochondritis Prevention Because inflammatory costochondritis has no definite cause, there is no good way to prevent it. Costochondritis Outlook Noninfectious costochondritis will go away on its own, with or without anti-inflammatory treatment. [webmd.com]

1. Gijsbers E, Knaap SFC. Clinical presentation and chiropractic treatment of Tietze syndrome: A 34-year-old female with left-sided chest pain. Journal of Chiropractic Medicine. 2011;10(1):60-63.
2. Volterrani L, Mazzei MA, Giordano N, Nuti R, Galeazzi M, Fioravanti A. Magnetic resonance imaging in Tietze's syndrome. Clin Exp Rheumatol. 2008 Sep-Oct;26(5):848-53.
3. Fioravanti A, Tofi C, Volterrani L, Marcolongo R. Malignant lymphoma presenting as Tietze's syndrome. Arthritis Rheum. 2002;47(3):229-230.
4. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009;80(6):617-620.
5. Kaplan T, Gunal N, Gulbahar G, et al. Painful Chest Wall Swellings: Tietze Syndrome or Chest Wall Tumor? Thorac Cardiovasc Surg. 2016;64(3):239-244.