Tietze's Syndrome

Abstract

Little has appeared about this condition in recent years in Great Britain, but our experience suggests that it may be more common than supposed, and may need to be considered in a differential diagnosis of chest pain. Tietze (1921) described a condition of painful non-suppurative swelling of the costochondral or sternoclavicular joints. The following criteria should be met:( The latest review is that of Karon, Achor, and Janes (1958), who reported their findings in six females and seven males, in whom the symptoms of swelling had persisted for from 3 days to more than 3 years. Present InvestigationsThree cases recently studied are described below: Case 1, a previously fit but slightly obese male aged 25, complained of pain in the right anterior region of the chest for 2 months. This had followed an upper respiratory tract infection and unproductive cough. Shortly after this, he had noticed tender swellings over the right second, third, and fourth costosternal junctions. These had persisted despite local application of heat and a course of achromycin.At this time the patient was in normal health apart from the swellings. The erythrocyte sedimentation rate was 54 mm./hr (Westergren), and the total white cell count 14,700/c.mm., with 43 per cent. lymphocytes.There was a pyrexia of 99. 40 F. An oval, tender swelling, 3 in. by 2 in., was fixed to the deep structures over the second right costochondral junction, and these changes were found to a lesser degree over the third and fourth costosternal junctions. A diagnosis of Tietze's syndrome was made, but in view of a persistent slight pyrexia and raised erythrocyte sedimentation rate not previously found in this condition, a full series of investigations were carried out.Laboratory Tests.-A chest radiograph and tomography of the costochondral junction showed no abnormality. The Wassermann reaction and Kahn test were negative. The blood cholesterol, uric acid, and electrolytes were normal. The agglutination tests for Brucella abortus and B. melitensis, typhoid, and paratyphoid showed no rise in the antibodies to these infections. The Paul Bunnell reaction was negative. There was no increase in the cold agglutinins. The Rose-Waaler test was negative, and the antistreptolysin titre was only 90 Todd units/c.mm.Therapy.-Local pain and swelling persisted, and continued to be accompanied by a mild pyrexia with a raised erythrocyte sedimentation rate and lymphocytosis. Because of this, oral prednisolone 5 mg. three times daily was prescribed, and within 3 days there was a marked improvement, with disappearance of pain, diminution of the swelling, and a fall in the temperature and erythrocyte sedimentation rate.Biopsy.-A biopsy of the third costal cartilage was taken through a transverse anterior chest incision. The

Tietze’s Syndrome in the emergency department: A rare etiology of atraumatic chest pain

“…It is most commonly diagnosed in 20 to 50 year old patients, but can strike young pediatric and elderly patients [6,9,10]. There is a wide range of sex distribution reported, ranging from equal to twice as common in females than males [6,7,11,12]. The onset of pain can be sudden or gradual, and it is often pleuritic or aggravated my movement [7,11,13].…”

“…A 2008 study recommends MRI and a 2010 review recommended bone scintigraphy and ultrasound as screening tests [11,15]. There have been some histological inquiries, but the studies have thus far deemed histology to be unrevealing or unimportant [3,6,12].…”