Painful Chest Wall Swellings: Tietze Syndrome or Chest Wall Tumor?

Abstract

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.

Keywords

chest wall tumor - computed tomography - surgery - bone scintigraphy

• References

• 1 Jurik AG, Graudal H. Sternocostal joint swelling—clinical Tietze's syndrome. Report of sixteen cases and review of the literature. Scand J Rheumatol 1988; 17 (1) 33-42
• 2 Semble EL, Wise CM. Chest pain: a rheumatologist's perspective. South Med J 1988; 81 (1) 64-68
• 3 Hsu PK, Hsu HS, Lee HC , et al. Management of primary chest wall tumors: 14 years' clinical experience. J Chin Med Assoc 2006; 69 (8) 377-382
• 4 Toussirot E, Gallinet E, Augé B, Voillat L, Wendling D. Anterior chest wall malignancies. A review of ten cases. Rev Rhum Engl Ed 1998; 65 (6) 397-405
• 5 Cocco R, Galieni P, Bellan C, Fioravanti A. Lymphomas presenting as Tietze's syndrome: a report of 4 clinical cases [in Italian]. Ann Ital Med Int 1999; 14 (2) 118-123
• 6 Jeon IH, Jeong WJ, Yi JH, Kim HJ, Park IH. Non-Hodgkin's lymphoma at the medial clavicular head mimicking Tietze Syndrome. Rheumatol Int 2012; 32 (8) 2531-2534
• 7 Aeschlimann A, Kahn MF. Tietze's syndrome: a critical review. Clin Exp Rheumatol 1990; 8 (4) 407-412
• 8 Fam AG. Approach to musculoskeletal chest wall pain. Prim Care 1988; 15 (4) 767-782
• 9 Wise CM, Semble EL, Dalton CB. Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients. Arch Phys Med Rehabil 1992; 73 (2) 147-149
• 10 Edelstein G, Levitt RG, Slaker DP, Murphy WA. Computed tomography of Tietze syndrome. J Comput Assist Tomogr 1984; 8 (1) 20-23
• 11 Honda N, Machida K, Mamiya T , et al. Scintigraphic and CT findings of Tietze's syndrome: report of a case and review of the literature. Clin Nucl Med 1989; 14 (8) 606-609
• 12 Hoffer PB, Genant HK. Radionuclide joint imaging. Semin Nucl Med 1976; 6 (1) 121-137
• 13 Incarbone M, Pastorino U. Surgical treatment of chest wall tumors. World J Surg 2001; 25 (2) 218-230
• 14 Lakunich JM, Sugurbaker DJ. Chest wall and pleura. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, , eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 17th ed. Philadelphia, PA: Elsevier Saunders; 2004: 1715-1717
• 15 Burt M. Primary malignant tumors of the chest wall. The Memorial Sloan-Kettering Cancer Center experience. Chest Surg Clin N Am 1994; 4 (1) 137-154
• 16 Friesenbichler J, Leithner A, Maurer-Ertl W , et al. Surgical therapy of primary malignant bone tumours and soft tissue sarcomas of the chest wall: a two-institutional experience. Int Orthop 2014; 38 (6) 1235-1240
• 17 Bagheri R, Haghi SZ, Kalantari MR , et al. Primary malignant chest wall tumors: analysis of 40 patients. J Cardiothorac Surg 2014; 9 (1) 106-111
• 18 Sabanathan S, Salama FD, Morgan WE, Harvey JA. Primary chest wall tumors. Ann Thorac Surg 1985; 39 (1) 4-15
• 19 David EA, Marshall MB. Review of chest wall tumors: a diagnostic, therapeutic, and reconstructive challenge. Semin Plast Surg 2011; 25 (1) 16-24
• 20 De Filippo M, Albini A, Castaldi V , et al. MRI findings of Tietze's syndrome mimicking mediastinal malignancy on MDCT. Eur J Radiol Extra 2008; 65: 33-35
• 21 Massie JD, Sebes JI, Cowles SJ. Bone scintigraphy and costochondritis. J Thorac Imaging 1993; 8 (2) 137-142
• 22 McKillop JH, Etcubanas E, Goris ML. The indications for and limitations of bone scintigraphy in osteogenic sarcoma: a review of 55 patients. Cancer 1981; 48 (5) 1133-1138
• 23 Sabanathan S, Shah R, Mearns AJ. Surgical treatment of primary malignant chest wall tumours. Eur J Cardiothorac Surg 1997; 11 (6) 1011-1016
• 24 Anderson BO, Burt ME. Chest wall neoplasms and their management. Ann Thorac Surg 1994; 58 (6) 1774-1781
• 25 Ramming KP, Holmes EC, Zarem HA, Lesavoy MA, Morton DL. Surgical management and reconstruction of extensive chest wall malignancies. Am J Surg 1982; 144 (1) 146-152
• 26 Eng J, Sabanathan S, Mearns AJ. Chest wall reconstruction after resection of primary malignant chest wall tumours. Eur J Cardiothorac Surg 1990; 4 (2) 101-104
• 27 Pairolero PC, Arnold PG. Chest wall tumors. Experience with 100 consecutive patients. J Thorac Cardiovasc Surg 1985; 90 (3) 367-372