RESUMEN
Tietze's syndrome (TS) is an inflammatory disorder characterised by painful, non-suppurative swelling in the sternocostal or sternoclavicular joint. The aetiology of TS is unknown. Herein, we described a case of isolated enthesitis in the sternocostal joint in a 42-year-old male patient whose clinical course led to the diagnosis of TS. A 42-year-old male Japanese patient (HLA-B27 negative) presented with chronic anterior chest wall pain. Mild swelling and tenderness were found in the right, third sternocostal joint (rt.3STCJ). No other arthralgia was present. Ultrasonography (US) of the rt.3STCJ showed hypoechoic thickening and power Doppler signal in the anterior radiate sternocostal ligament with mild synovial hypertrophy of the STCJ. US also depicted cortical bone erosion at the sternum with neovascularisation. Magnetic resonance imaging with T2-weighted short-tau inversion recovery showed high signal intensity in the bone marrow of the sternum and adjacent soft tissue around the rt.3STCJ. Based on these findings, TS with the enthesitis in the rt.3STCJ was diagnosed. The patient received a US-guided corticosteroid injection, and the symptoms completely resolved 10 months later. Enthesitis may cause TS. US is a readily available, sensitive imaging technique useful for diagnosing TS.
Asunto(s)
Síndrome de Tietze , Masculino , Humanos , Adulto , Síndrome de Tietze/diagnóstico , Síndrome de Tietze/patología , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Imagen por Resonancia Magnética , Ultrasonografía , Edema/diagnósticoAsunto(s)
Absceso/diagnóstico , Absceso/microbiología , Infecciones Estafilocócicas/diagnóstico , Staphylococcus aureus/aislamiento & purificación , Síndrome de Tietze/diagnóstico , Síndrome de Tietze/microbiología , Absceso/terapia , Femenino , Humanos , Persona de Mediana Edad , Infecciones Estafilocócicas/terapia , Síndrome de Tietze/terapiaRESUMEN
Infection of costal cartilage is a rare observation. We report the case of a 43-year-old male patient without relevant history who presented with a progressive painful swelling of the left chest wall since 4 months. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated an abscess within the left ninth costal cartilage with surrounding reactive changes. A CT-guided biopsy was performed and the culture of the sample revealed the presence of Prevotella nigrescens. Musculoskeletal infections by Prevotella are rarely described in the literature, Prevotella oralis and Prevotella bivia being the most frequently observed pathogens. These infections usually originate from a hematogenous spread after thoracic surgery or dental procedure. In our patient, conservative treatment was chosen. A clinical improvement was noted after 1-month antibiotherapy, confirmed by short-term and 6-month imaging follow-up showing the complete disappearance of all previously observed abnormalities.
Asunto(s)
Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/terapia , Prevotella nigrescens , Síndrome de Tietze/diagnóstico , Síndrome de Tietze/microbiología , Adulto , Humanos , Masculino , Síndrome de Tietze/terapiaAsunto(s)
Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Clavícula/fisiopatología , Edema/tratamiento farmacológico , Dolor/tratamiento farmacológico , Síndrome de Tietze/diagnóstico , Síndrome de Tietze/tratamiento farmacológico , Adolescente , Clavícula/efectos de los fármacos , Humanos , Masculino , Resultado del TratamientoAsunto(s)
Dolor Abdominal/etiología , Síndromes de Compresión Nerviosa/complicaciones , Síndromes de Compresión Nerviosa/diagnóstico , Adulto , Apendicitis/diagnóstico , Arteria Celíaca/anomalías , Colecistitis Aguda/diagnóstico , Enfermedad Crónica , Constricción Patológica/diagnóstico , Diagnóstico Diferencial , Femenino , Hernia Ventral/diagnóstico , Humanos , Cálculos Renales/diagnóstico , Síndrome del Ligamento Arcuato Medio , Isquemia Mesentérica/diagnóstico , Síndromes de Compresión Nerviosa/terapia , Quistes Ováricos/diagnóstico , Úlcera Péptica/diagnóstico , Síndrome de Tietze/diagnósticoRESUMEN
BACKGROUND: Tietze syndrome (TS) is an inflammatory condition characterized by chest pain and swelling of costochondral junction. Primary chest wall tumors may mimic TS. In this article, we report our experience of approximately 121 patients initially diagnosed as TS and determined chest wall tumor in some cases at the follow-up. METHODS: This is a retrospective review of patients diagnosed as TS by clinical examination, chest X-ray, electrocardiogram, routine laboratory tests, and computed tomography (CT) of chest: all treated and followed up between March 2001 and July 2012. There were 121 cases (41 males and 80 females; mean age, 39.6 ± 3.2 years) of TS. RESULTS: In 27 patients with initial normal radiological findings, the size of swellings had doubled during the follow-up period (mean, 8.51 ± 2.15 months). These patients were reevaluated with chest CT and bone scintigraphy and then early diagnostic biopsy was performed. Pathologic examination revealed primary chest wall tumor in 13 patients (5 malignant, 8 benign). CT had a sensitivity of 92.3% and a specificity of 64.2% in detection of tumors (kappa: 0.56, p = 0.002), whereas the sensitivity and the specificity of bone scan were 84.6 and 35.7%, respectively (kappa: 0.199, p = 0.385). CONCLUSION: Primary chest wall tumors could mimic TS. Bone scintigraphy or CT is not specific enough to determine malignant and other benign disorders of costochondral junction. Therefore, clinicians should follow TS patients more closely, and in case of increasing size of swelling, early diagnostic biopsy should be considered.
Asunto(s)
Dolor en el Pecho/etiología , Radiografía Torácica/métodos , Neoplasias Torácicas/diagnóstico , Pared Torácica/diagnóstico por imagen , Síndrome de Tietze/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Adulto , Dolor en el Pecho/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Torácicas/complicaciones , Síndrome de Tietze/complicaciones , Adulto JovenRESUMEN
A simple clinical approach to patients presenting with chest pain is outlined, which is easily taught and can be quickly applied. This approach was demonstrated in a large cohort of patients and this article discusses the characteristics of the various diagnostic sub-groups.
Asunto(s)
Dolor en el Pecho/diagnóstico , Anamnesis , Dolor Referido/diagnóstico , Examen Físico , Adulto , Anciano , Dolor en el Pecho/etiología , Estudios de Cohortes , Dispepsia/complicaciones , Dispepsia/diagnóstico , Femenino , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Dolor Referido/etiología , Pleuresia/complicaciones , Pleuresia/diagnóstico , Síndrome de Tietze/complicaciones , Síndrome de Tietze/diagnóstico , Factores de TiempoRESUMEN
This article summarizes the evaluation and treatment of musculoskeletal causes of chest pain. Conditions such as costochondritis, rib pain caused by stress fractures, slipping rib syndrome, chest wall muscle injuries, fibromyalgia, and herpes zoster are discussed, with emphasis on evaluation and treatment of these and other disorders. Many of these conditions can be diagnosed by the primary care clinician in the office by history and physical examination. Treatment is also discussed, including description of manual therapy and exercises as needed for some of the conditions.
Asunto(s)
Dolor en el Pecho/etiología , Enfermedades Musculoesqueléticas/complicaciones , Síndrome de Hiperostosis Adquirido/diagnóstico , Síndrome de Hiperostosis Adquirido/terapia , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/terapia , Humanos , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/terapia , Músculos Pectorales/lesiones , Examen Físico , Fracturas de las Costillas/diagnóstico , Fracturas de las Costillas/terapia , Esguinces y Distensiones/diagnóstico , Esguinces y Distensiones/terapia , Síndrome de Tietze/diagnóstico , Síndrome de Tietze/terapiaRESUMEN
BACKGROUND: Chest pain is a common complaint and reason for consultation in primary care. Traditional textbooks still assign pain localization a certain discriminative role in the differential diagnosis of chest pain. The aim of our study was to synthesize pain drawings from a large sample of chest pain patients and to examine whether pain localizations differ for different underlying etiologies. METHODS: We conducted a cross-sectional study including 1212 consecutive patients with chest pain recruited in 74 primary care offices in Germany. Primary care providers (PCPs) marked pain localization and radiation of each patient on a pictogram. After 6 months, an independent interdisciplinary reference panel reviewed clinical data of every patient, deciding on the etiology of chest pain at the time of patient recruitment. PCP drawings were entered in a specially designed computer program to produce merged pain charts for different etiologies. Dissimilarities between individual pain localizations and differences on the level of diagnostic groups were analyzed using the Hausdorff distance and the C-index. RESULTS: Pain location in patients with coronary heart disease (CHD) did not differ from the combined group of all other patients, including patients with chest wall syndrome (CWS), gastro-esophageal reflux disease (GERD) or psychogenic chest pain. There was also no difference in chest pain location between male and female CHD patients. CONCLUSIONS: Pain localization is not helpful in discriminating CHD from other common chest pain etiologies.
Asunto(s)
Dolor en el Pecho/fisiopatología , Enfermedad Coronaria/diagnóstico , Reflujo Gastroesofágico/diagnóstico , Trastornos Psicofisiológicos/diagnóstico , Síndrome de Tietze/diagnóstico , Dolor en el Pecho/etiología , Estudios de Cohortes , Enfermedad Coronaria/complicaciones , Estudios Transversales , Diagnóstico Diferencial , Femenino , Reflujo Gastroesofágico/complicaciones , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Masculino , Examen Físico , Pleuroneumonía/complicaciones , Pleuroneumonía/diagnóstico , Atención Primaria de Salud , Trastornos Psicofisiológicos/complicaciones , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/diagnóstico , Gastropatías/complicaciones , Gastropatías/diagnóstico , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/diagnóstico , Síndrome de Tietze/complicacionesRESUMEN
Approximately 1 percent of primary care office visits are for chest pain, and 1.5 percent of these patients will have unstable angina or acute myocardial infarction. The initial goal in patients presenting with chest pain is to determine if the patient needs to be referred for further testing to rule in or out acute coronary syndrome and myocardial infarction. The physician should consider patient characteristics and risk factors to help determine initial risk. Twelve-lead electrocardiography is typically the test of choice when looking for ST segment changes, new-onset left bundle branch block, presence of Q waves, and new-onset T wave inversions. For persons in whom the suspicion for ischemia is lower, other diagnoses to consider include chest wall pain/costochondritis (localized pain reproducible by palpation), gastroesophageal reflux disease (burning retrosternal pain, acid regurgitation, and a sour or bitter taste in the mouth), and panic disorder/anxiety state. Other less common but important diagnostic considerations include pneumonia (fever, egophony, and dullness to percussion), heart failure, pulmonary embolism (consider using the Wells criteria), acute pericarditis, and acute thoracic aortic dissection (acute chest or back pain with a pulse differential in the upper extremities). Persons with a higher likelihood of acute coronary syndrome should be referred to the emergency department or hospital.
Asunto(s)
Dolor en el Pecho/etiología , Atención Primaria de Salud , Síndrome Coronario Agudo/diagnóstico , Enfermedad Aguda , Adulto , Disección Aórtica/diagnóstico , Ansiedad/diagnóstico , Aneurisma de la Aorta Torácica/diagnóstico , Técnicas de Apoyo para la Decisión , Diagnóstico Diferencial , Electrocardiografía , Reflujo Gastroesofágico/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Humanos , Anamnesis , Infarto del Miocardio/diagnóstico , Trastorno de Pánico/diagnóstico , Pericarditis/diagnóstico , Examen Físico , Neumonía/diagnóstico , Embolia Pulmonar/diagnóstico , Medición de Riesgo , Factores de Riesgo , Síndrome de Tietze/diagnósticoRESUMEN
We present a case of Non-Hodgkin's lymphoma involving medial clavicular head, which was initially diagnosed as Tietze syndrome. Non-Hodgkin's lymphoma arising from medial clavicular head is extremely rare, and CT, MRI findings have not been reported.
Asunto(s)
Clavícula/patología , Errores Diagnósticos , Linfoma de Células B Grandes Difuso/diagnóstico , Síndrome de Tietze/diagnóstico , Biopsia , Femenino , Humanos , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/patología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Imagen Multimodal , Necrosis , Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Articulación Esternoclavicular/patología , Síndrome de Tietze/patología , Tomografía Computarizada por Rayos X , Imagen de Cuerpo EnteroRESUMEN
Chest wall abscess may occur as primary infection or secondary to open trauma or thoracic wall surgery. The authors describe an unusual case of Escherichia coli costochondritis occurring 2 months after a blunt chest wall trauma. Primary chest wall abscess due to E coli costochondritis has been previously reported only twice occurring after urinary tract infection. All other very few reports of E coli costochondritis have been reported only after thoracic surgical procedures. 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. C albicans costochondritis was most commonly reported among heroin addicts. The appearance of a growing chest wall mass should always prompt a search for an infectious cause, even with little or no systemic signs and symptoms.
Asunto(s)
Absceso/diagnóstico , Infecciones por Escherichia coli/diagnóstico , Enfermedades Torácicas/diagnóstico , Pared Torácica , Síndrome de Tietze/diagnóstico , Absceso/microbiología , Absceso/patología , Anciano , Infecciones por Escherichia coli/patología , Femenino , Humanos , Enfermedades Torácicas/microbiología , Enfermedades Torácicas/patología , Pared Torácica/microbiología , Pared Torácica/patología , Síndrome de Tietze/microbiología , Síndrome de Tietze/patologíaRESUMEN
Secondary chest wall infections after previous surgical procedures are well known but the primary form of this is a relatively rare entity. We present a case of a 34-year-old man who suffered from primary suppurative costochondritis diagnosed by ultrasound and chest CT scan. The patient underwent a wide necrosectomy with a muscle flap reconstruction.
Asunto(s)
Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Pared Torácica/cirugía , Síndrome de Tietze/diagnóstico , Síndrome de Tietze/cirugía , Adulto , Humanos , Masculino , Supuración , Mallas Quirúrgicas , Pared Torácica/patología , Síndrome de Tietze/patología , Resultado del TratamientoRESUMEN
BACKGROUND: A 54-year-old previously healthy white man presented to hospital with fever, right parasternal pain and swelling over the right second and third costochondral joints. The symptoms had developed 1 week earlier. INVESTIGATIONS: Physical examination, white blood cell count, erythrocyte sedimentation rate, C-reactive protein level, blood and urine culture, plain radiography and CT of the chest, (99m)Tc bone scintigraphy, ultrasound-guided needle aspiration of soft tissue mass, Gram staining and culture of aspirated fluid. DIAGNOSIS: Meticillin-sensitive Staphylococcus aureus costochondritis. MANAGEMENT: CT revealed a 2 x 5 cm soft tissue mass at the posterior aspect of the right second and third costochondral joints. The fluid aspirated contained Gram-positive cocci, and culture revealed the presence of meticillin-sensitive S. aureus. The patient received a 6-week course of flucloxacillin (2 g by intravenous injection every 6 h for 2 weeks, then 1 g orally every 6 h for 4 weeks). He responded well to treatment, and was discharged from hospital.
Asunto(s)
Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Síndrome de Tietze/microbiología , Antibacterianos/uso terapéutico , Floxacilina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Síndrome de Tietze/diagnóstico , Síndrome de Tietze/tratamiento farmacológicoRESUMEN
The term costochondritis (ChC) indicates a painful and persistent inflammation at the costochondral or costosternal junction. The usual conservative treatment (NSAIDs), local splinting, local heat) and sometimes disappointing. The aim of this study is to evaluate the effect of stretching exercises in a group of patients affected with ChC. This retrospective open study involved 51 outpatients with diagnosis of ChC: thirty four consecutive patients were treated with stretching exercises, 34 patients matched for age, pain and disease duration constituted the control group. All the patients had spontaneous pain at least in the one of the costochondral junctions at the third to seventh rib. The intensity of spontaneous pain was measured by means of the visual analogic scale of Scott-Huskisson. The homogeneity of the two groups at the beginning of the study was checked for VAS, for disease duration and age by means of Mann-Whitney test for non-parametric measures. The statistical analysis of pain was done by Friedman analysis of variance and Student-Newman-Keuls multiple comparisons tests. The results showed a progressive significant amelioration in patients treated with stretching exercises as respect as the control group (p<0.001). The goal of therapy of costochondritis is to reduce inflammation and the pain. The NSAIDs, local injection of anaesthetic or steroid has insufficient effectiveness. The possibility to improve the pain by means of simple stretching exercises can supply a useful instrument in order to treat the condition of these patients.
Asunto(s)
Dolor en el Pecho/terapia , Ejercicios de Estiramiento Muscular/métodos , Síndrome de Tietze/terapia , Anciano , Estudios de Casos y Controles , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Calidad de Vida , Recuperación de la Función , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Síndrome de Tietze/complicaciones , Síndrome de Tietze/diagnósticoAsunto(s)
Síndrome de Tietze/diagnóstico , Síndrome de Tietze/terapia , Adolescente , Adulto , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Dolor en el Pecho/tratamiento farmacológico , Dolor en el Pecho/etiología , Humanos , Examen Físico , Síndrome de Tietze/complicaciones , Adulto JovenRESUMEN
Costochondritis, an inflammation of costochondral junctions of ribs or chondrosternal joints of the anterior chest wall, is a common condition seen in patients presenting to the physician's office and emergency department. Palpation of the affected chondrosternal joints of the chest wall elicits tenderness. Although costochondritis is usually self-limited and benign, it should be distinguished from other, more serious causes of chest pain. Coronary artery disease is present in 3 to 6 percent of adult patients with chest pain and chest wall tenderness to palpation. History and physical examination of the chest that document reproducible pain by palpation over the costal cartilages are usually all that is needed to make the diagnosis in children, adolescents, and young adults. Patients older than 35 years, those with a history or risk of coronary artery disease, and any patient with cardiopulmonary symptoms should have an electrocardiograph and possibly a chest radiograph. Consider further testing to rule out cardiac causes if clinically indicated by age or cardiac risk status. Clinical trials of treatment are lacking. Traditional practice is to treat with acetaminophen or anti-inflammatory medications where safe and appropriate, advise patients to avoid activities that produce chest muscle overuse, and provide reassurance.