What are the diagnostic criteria for Tietze's syndrome?

Diagnostic Criteria for Tietze's Syndrome

Tietze's syndrome is diagnosed primarily by clinical examination showing tenderness of costochondral joints, typically with localized inflammation and swelling of the affected joint, most commonly involving the second and third ribs. 1

Key Diagnostic Features

Required Clinical Findings

• Localized pain and tenderness at the costochondral, sternocostal, or sternoclavicular joints 1
• Visible or palpable swelling of the affected joint 2
• Pain that may be reproduced by palpation of the affected area 3
• Typically unilateral involvement 2

Laboratory and Imaging Findings

• Inflammatory markers may be elevated 2
• Chest radiography should be normal (used primarily to exclude other conditions) 1
• CT shows lower sensitivity (84.6%) and specificity (35.7%) compared to other modalities for differentiating Tietze's syndrome from primary chest wall tumors 1
• Bone scintigraphy is highly sensitive for detecting costochondral inflammation but lacks specificity for differentiating Tietze's syndrome from bone tumors 1

Differential Diagnosis

Tietze's syndrome must be differentiated from:

• Costochondritis (similar presentation but without the visible swelling) 1
• Acute coronary syndrome (ECG should be performed within 10 minutes of presentation) 1
• Pulmonary embolism (typically presents with tachycardia, dyspnea, and pain with inspiration) 1
• Pneumothorax (presents with dyspnea, pleuritic pain, and unilateral absence of breath sounds) 1
• Malignant chest wall tumors (may mimic Tietze's syndrome) 4
• Infectious osteomyelitis (typically with systemic symptoms and elevated inflammatory markers) 1

Diagnostic Algorithm

1. Clinical examination:

   • Identify localized tenderness and swelling at costochondral junctions
   • Document which ribs are affected (most commonly 2nd and 3rd)
   • Assess for reproduction of pain with palpation

2. Rule out life-threatening causes:

   • ECG to exclude cardiac causes 1
   • Chest radiography to exclude pulmonary pathology 1, 3

3. Additional testing (if diagnosis remains unclear):

   • Laboratory tests to check inflammatory markers 2
   • Ultrasound of the affected area (higher sensitivity than CT for chest wall involvement) 1
   • MRI or CT if malignancy is suspected 1

4. Confirm diagnosis when:

   • Life-threatening causes are excluded
   • Localized swelling and tenderness at costochondral junction is present
   • Self-limiting, benign course is observed 2

Important Clinical Considerations

• Tietze's syndrome is a benign, self-limiting condition 2
• It can mimic serious conditions including cardiac, pulmonary, and intra-abdominal pathologies 5
• The condition affects all ages, sexes, and races equally 5
• Pain may be referred to other areas due to autonomic nerve connections 5
• In rare cases where conservative treatment fails, surgical management with resection of the involved cartilage may be considered 6

Treatment Approach

While not part of the diagnostic criteria, treatment response can support the diagnosis:

• NSAIDs for 1-2 weeks typically provide relief 3
• Local anesthetic infiltration to the affected joint can provide prompt relief in most cases (87.5%) 5
• For medically refractory cases, surgical resection of the involved cartilage may be considered 6

Remember that Tietze's syndrome can be easily confused with costochondritis, but the presence of visible or palpable swelling is the key distinguishing feature of Tietze's syndrome.