Tietze's syndrome

Tietze syndrome
Classification and external resources
Sternocostal and interchondral articulations. Anterior view. (Costal cartilages visible on diagram.)
ICD-10	M94.0
ICD-9	733.6
DiseasesDB	13112
MeSH	D013991

Tietze syndrome is a benign inflammation of one or more of the costal cartilages. It was first described in 1921 by the German surgeon Alexander Tietze (1864-1927).^[1][2]

While similar, Tietze syndrome is not identical to costochondritis. Tietze syndrome is characterized by swelling of the costal cartilages, while in costochondritis there is no swelling. It is now recognized that the presence or absence of swelling is only an indicator of the severity of the condition. It was at one time thought to be associated with, or caused by, a viral infection acquired during surgery, but this is now known not to be the case. Most sufferers have not had recent surgery.

Presentation

The primary presentation of the syndrome is significant, acute pain in the chest, along with tenderness and some swelling of the cartilages affected, which is commonly palpable on examination. Although many times it can be extremely painful, to the point of being debilitating, Tietze's Syndrome is considered to be a benign condition that generally resolves in 12 weeks. However, it can often be a chronic condition.

Perceived pain is often exacerbated with respiration.

Costochondritis symptoms are similar to Tietze's, the prime difference being that the pain radiates to the arms and shoulders in the latter.

Cause

While the true causes of Tietze's Syndrome are not well understood, it often results from a physical strain or minor injury, such as repeated coughing, vomiting or impacts to the chest. It has even been known to occur after hearty bouts of laughter. It can occur by over exerting or by an injury in the chest and breast.

Psychological stress can exacerbate Tietze's Syndrome, but it is not a direct cause.

Patients who have had radiation therapy to the chest/breast will often experience this syndrome which can occur shortly after therapy or years down the road.

Theoretical cause of Costochondritis and/or Tietze's Syndrome:

The following information is only theorized by Ryan Matthew Conard and should not be taken as a conclusive medical or scientific cause for Costochondritis or Tietze's Syndrome.

It is possible that Costochondritis may be directly caused by cold water shock ("cold shock"). As best noted by Ryan Conard, he first experienced Costochondritis immediately after a full immersion into cold water (below 50oF). This immediate onset of Costochondritis can best be conceived by the body's reaction to sudden, very cold temperatures in water. When your body is immediately immersed in cold water it involuntarily gasps for air, up to the full volume your lungs can support, then afterward you involuntarily hyperventilate for 1-3 minutes. This reaction of your body to cold water is known as "cold shock." The first large, and very sudden gasp for air could be the leading cause to Costochondritis in this particular case. Whereas, once the body hits the cold water causing "cold shock" and forcing your body to gasp for air violently there is a chance you may damage any of the three layers of intercostal muscles between the ribs (including External, Internal and Innermost), thus resulting in the cause for Costochondritis.

Differential diagnosis

Although patients will often mistake the pain of Tietze's Syndrome for a myocardial infarction (heart attack), the syndrome does not progress to cause harm to any organs.

It is important to rule out a heart attack, as the symptoms can be similar. After assessment, doctors often reassure patients that their symptoms are not associated with a heart attack, although they may need to treat the pain, which in some cases can be severe enough to cause significant but temporary disability to the patient. It can also be triggered off by coughing or sneezing. However patients with the syndrome can be at high risk if falling asleep while in pain, of suffering cardiac arrest^{[citation needed]}

References

1. ^ synd/2640 at Who Named It?
2. ^ A. Tietze. Über eine eigenartige Häufung von Fällen mit Dystrophie der Rippenknorpel. Berliner klinische Wochenschrift, 1921, 58: 829-831.

External links

• Tietze's Syndrome Info site
• Overview at About.com
• NetDoctor
• Overview at Mayo Clinic
• Costochondritis and Tietze Syndrome
• Costochondritis at WebMD