First described by Alexander Tietze in 1921,^1,2 Tietze's syndrome has been defined as a benign, painful, non-suppurative localised swelling of the costosternal, sternoclavicular or costochondral joints, most often involving the area of the second and third ribs. Only one area is usually involved and young adults are more commonly affected.³ The syndrome is uncommon and self-limiting. The cause of Tietze's syndrome is unknown, but preceding upper respiratory infections and excessive coughing have been described in some patients.

Epidemiology

• Tietze's syndrome can present at any age but is most common in those aged 20 to 30 years.
• Tietze's syndrome is twice as frequent in men as in women.

Presentation

• May be acute or gradual onset. The patient complains of pain that is often localised to the costal cartilage.
• The syndrome usually affects the upper ribs, especially the second or third ribs.
• The pain is aggravated by physical activity, movement, coughing or sneezing.
• There is localised tenderness.
• Although the pain usually disappears spontaneously, the swelling may persist long after the tenderness has disappeared.

Differential diagnosis

• Other causes of chest pain: the pain may be confused with that of myocardial infarction and is usually unilateral on the left side.
• Tietze's syndrome and costochondritis are not completely synonymous, as Tietze's syndrome is more localised and includes costochondral cartilage swelling, whereas costochondritis tends to be more diffuse and does not cause costochondral cartilage swelling.

Investigations

• Diagnosis can usually be made by careful history and examination.
• Investigations may be required to rule out other possible causes of chest pain.
• ECG to exclude cardiovascular conditions.
• Chest X-ray to exclude other pathologies.
• Ultrasound may have a role in assessment and diagnosis.⁴
• Magnetic resonance imaging (MRI) may also be useful and effective for some patients.⁵

Management

• Reassurance once the diagnosis is confirmed.
• Non-steroidal anti-inflammatory drugs.
• Local injection of long-acting corticosteroids may help.
• Intercostal nerve block may also help but is rarely required.

Prognosis

• The pain usually subsides within a few weeks, with some residual swelling persisting for longer periods of time.
• However, the course of the disease varies from spontaneous remission to persistent symptoms over years.