Tietze syndrome

Tietze syndrome is a benign condition characterised by a self-limiting inflammation of the costal cartilages often with hypertrophy. Although often described as such, it is not a costochondritis ⁹.

Epidemiology

The exact incidence of occurrence is not known. It is seen most commonly in the 2^nd to 5^th decades of life. Both sexes are affected equally.

Clinical presentation

It is characterised 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 localised and is not accompanied by any additional presenting symptoms.

Pathology

The pathogenesis of Tietze syndrome remains unknown but it is thought to relate to recurrent microtrauma and/or airway infection ⁹.

Radiographic features

MRI

MRI features of Tietze syndrome were characterised 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 oedema 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

Nuclear medicine

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.

Differential diagnosis

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