Tietze syndrome
Overview
A rare disorder characterized by inflammation, swelling, redness and tenderness of the rib cartilage (costochondrial cartilage) in the upper chest. The condition causes pain and can last from hours to weeks. The cause of the condition is unknown. Also called Tietze's syndrome.
Symptoms
* Redness * Swelling * Painful rib cage * Previous trauma * Worse with cough
Causes
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 is also a cause of Tietze's Syndrome. Preceding stressful events such as relationship problems, family issues or work related stress are very commonly associated with this syndrome.
Diagnosis
1. Is it diffuse or focal? Diffuse scrotal swelling would suggest congestive heart failure, nephrosis, uremia, and cirrhosis, as well as focal disease such as filariasis or bilateral hydrocele. Focal scrotal swelling would suggest a hernia, hydrocele, torsion of the testicle, abscesses, epididymitis, orchitis, varicoceles, and testicular tumors. 2. If it is diffuse, is there ascites or generalized edema? The presence of diffuse edema of the scrotum with ascites or generalized edema would suggest congestive heart failure, nephrosis, uremia, or cirrhosis. 3. If it is focal, is it painful? The presence of painful scrotal swelling would suggest an incarcerated or strangulated inguinal hernia, torsion of the testicle, a hematoma, orchitis, epididymitis, furuncle, or periurethral abscess. 4. Does it transilluminate? If the mass transilluminates, it is very likely a hydrocele of the testicle or a spermatocele. 5. Is it reducible? If the mass is reducible, it is most likely an inguinal hernia or a varicocele.
Prognosis
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 examination, 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. There is pain and discomfort in the chest wall of the patient. The pain is generally at night and in the morning, however it can affect the patient at any time of day. The patient must not move or exert during pain. The patient should lie down and lightly massage the affected area.
Treatment
Treatment consists of local heat, analgesics, anti-inflammatory drugs, or local steroid injections. These usually relieve symptoms. Most often the pain subsides after a few weeks or months but swelling may remain for a longer period of time.