What is Tietze syndrome?

Tietze syndrome is an inflammatory pathology of the costochondral and chondrosternal articular cartilage. Less frequently it affects the sternoclavicular joints or the manubrium-sternal or sterno-xiphoid joints. It is considered a rheumatic disease characterized by repeated relapsing painful episodes.

What is the etiology of Tietze syndrome?

The etiology is not known. Some studies have hypothesized that multiple microtraumas to the anterior chest wall may trigger the development of Tietze syndrome. It may occur more frequently in certain conditions, such as psoriatic arthritis. Sometimes the development of the disorder may be related to chronic and excessive coughing, vomiting, trauma or impact to the chest, viral or bacterial infections, or surgery in the thoracic area.

What are the symptoms of Tietze syndrome?

The clinic is characterized by pain, paresthesia and local swelling.
The pain is usually unilateral, localized, can arise either gradually or suddenly and is accentuated by breathing and lying prone. The pain may radiate to the ipsilateral shoulder and arm.
Tietze syndrome is described as a localized, painful, swollen, non-pustular mass, commonly without rubor or erythema. Palpatorially, the swelling is generally fusiform, soft in consistency and painful to acupressure. Sometimes it can present suppurative aspects.

How to diagnose Tietze syndrome?

Tietze syndrome is a diagnosis of exclusion after a thorough workup of life-threatening or more common diseases has been completed. An electrocardiogram (ECG) should be performed on all patients presenting with acute chest pain.

What are the laboratory findings in Tietze syndrome?

Laboratory findings for this syndrome are not specific. Laboratory tests may also show elevated inflammatory markers such as ESR or CRP.

What is the role of biopsy in Tietze syndrome?

Rib cartilage biopsy can lead to a more timely diagnosis if performed early in the progression of the disease.

What imaging tests can help in the diagnosis of Tietze syndrome?

The clinical diagnosis can possibly be confirmed by ultrasound examination. Ultrasound has proven to be the most effective modality for diagnosing Tietze syndrome as it can quickly demonstrate soft tissue swelling at the site of inflammation.
Another useful, although nonspecific, diagnostic tool is nuclear magnetic resonance imaging, which precisely identifies changes in nearby adipose tissue and bone marrow due to inflammation.
Radiographs are normal, whereas computed tomography (CT) may show mild focal swelling or mild sclerosing of the symptomatic joint.

With which diseases is the differential diagnosis of Tietze syndrome made?

It is critical at the time of initial presentation of acute chest pain that a broad differential diagnosis is considered.
It is necessary to exclude acute coronary syndrome, hypertensive crisis, inflammatory processes or infections of the lungs and accompanying pleura, malignant tumors, thoracic fractures associated with trauma, rheumatoid or pyogenic arthritis, gastroesophageal reflux disease or psychogenic disorders.
Tietze syndrome is most commonly misdiagnosed as costichondritis. Costochondritis, however, is associated with multiple ribs, typically 2 to 5, and is not associated with localized swelling on the affected joints.
Possible differential diagnoses are:

• Seronegative spondyloarthropathy
• Spondyloarthropathy
• Rheumatoid arthritis
• Xiphoidalgia
• Slippery rib syndrome
• Myelomalacia
• Primary tumors of bone and soft tissue
• Chondrosarcoma of the chondrocostal joints
• Costochondritis
• Breast and/or lung tumors with extension to the costal cartilage
• Metastasis of tumors of the breast, kidney and prostate
• Rib trauma and painful swelling of the ribs
• Arthritis of:
  • Sternoclavicular joint
  • Manumbrio-sternal joint

What is the evolution of Tietze syndrome?

The evolution of the syndrome is generally benign with symptoms that are often self-limiting, but relapses of Tietze syndrome are possible.

What is the treatment of Tietze syndrome?

Treatment of Tietze syndrome is conservative therapy and reassurance that this disease process often resolves on its own without permanent sequelae, many times within a few weeks.
Pharmacological therapy is symptomatic and involves the use of oral or topical non-steroidal anti-inflammatory drugs.
Patients may benefit from a targeted injection of local anesthetic, steroid, or both at the site of maximum swelling, which should be visualized via ultrasound.
Some patients have reported benefits with the application of heating pads to the affected area.
There are reports where cartilage has been resected as a treatment option in persistent and severe cases. However, this is not generally recommended and should only be considered a last option on a case-by-case basis.

What are the complications of Tietze syndrome?

There are usually no complications directly associated with Tietze syndrome, other than those potentially resulting from injections, medications, or surgery. These can include infections, drug reactions, drug side effects, and scarring.

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