The exact incidence of occurrence is not known. It is seen most commonly in the 2nd to 5th decades of life. Both sexes are affected equally.
It is characterized as a tender, non-suppurative swelling in the upper costosternal region. It can have an acute or gradual onset and may resolve spontaneously. It may mimic a myocardial infarction, but the pain in Tietze syndrome is more localized and is not accompanied by any additional presenting symptoms.
The pathogenesis of Tietze syndrome remains unknown but it is thought to relate to recurrent microtrauma and/or airway infection 9.
MRI features of Tietze syndrome were characterized according to one study as follows 1:
- enlargement and thickening of cartilage at the site of the complaint
- focal or widespread increased signal intensities of affected cartilage on both TSE T2-weighted and STIR/T2 fat-saturated images
- bone marrow edema in the subchondral bone
- intense gadolinium enhancement in the areas of thickened cartilage, in the subchondral bone marrow, and/or in the capsule and ligaments
Ga-67 imaging often shows increased radiotracer uptake 7.
Treatment and prognosis
It is a benign condition that may subside spontaneously. Some authors suggest local steroid injection as a possible treatment option 6.
History and etymology
First described in 1921 by Alexander Tietze (1864-1927), a German surgeon 8,9.
The differential diagnosis of Tietze syndrome runs the full spectrum of musculoskeletal chest wall pain, as well as:
- costochondritis: no costal cartilage hypertrophy, typically older population
- rheumatoid arthritis of the costosternal, sternoclavicular, or manubriosternal joints
- ankylosing spondylitis: uncommon in the costosternal joint, other typical manifestations
- primary and secondary bone neoplasms
- slipping rib syndrome
- 1. Volterrani L, Mazzei MA, Giordano N et-al. Magnetic resonance imaging in Tietze's syndrome. Clin Exp Rheumatol. 2009;26 (5): 848-53. Pubmed citation
- 2. Martino F, D'Amore M, Angelelli G et-al. Echographic study of Tietze's syndrome. Clin. Rheumatol. 1991;10 (1): 2-4. Pubmed citation
- 3. Aeschlimann A, Kahn MF. Tietze's syndrome: a critical review. Clin. Exp. Rheumatol. 1990;8 (4): 407-12. Pubmed citation
- 4. Kamel M, Kotob H. Ultrasonographic assessment of local steroid injection in Tietze's syndrome. Br. J. Rheumatol. 1997;36 (5): 547-50. Pubmed citation
- 5. Jurik AG, Justesen T, Graudal H. Radiographic findings in patients with clinical Tietze syndrome. Skeletal Radiol. 1988;16 (7): 517-23. Pubmed citation
- 6. Kamel M, Kotob H. Ultrasonographic assessment of local steroid injection in Tietze's syndrome. Br J Rheumatol. 1997;36 (5): 547-50. Pubmed citation
- 7. Honda N, Machida K, Mamiya T et-al. Scintigraphic and CT findings of Tietze's syndrome: report of a case and review of the literature. Clin Nucl Med. 1989;14 (8): 606-9. Pubmed citation
- 8. Tietze A. Űber eine eigenartige Häufung von Fällen mit Dystrophie der Rippenknorpel. Berliner klinische Wochenschrift. 1921;58:829–831.
- 9. Rokicki W, Rokicki M, Rydel M. What do we know about Tietze's syndrome?. (2018) Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery. 15 (3): 180-182. doi:10.5114/kitp.2018.78443 - Pubmed