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


CONCLUSIONS
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.
Department of Thoracic Surgery, Ufuk University School of Medicine, Ankara, Turkey.
Tevfik
T
Kaplan
Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey.
Nesimi
N
Gunal
Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
Gultekin
G
Gulbahar
Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
Bulent
B
Kocer
Department of Thoracic Surgery, Ufuk University School of Medicine, Ankara, Turkey.
Serdar
S
Han
Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
Mehmet Ali
MA
Eryazgan
Department of Radiology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
Arzu
A
Ozsoy
Department of Nuclear Medicine, Ankara Numune Teaching And Research Hospital, Ankara, Turkey.
Seniha
S
Naldoken
Department of Statistics, Ufuk University Faculty of Arts and Science, Ankara, Turkey.
Aslıhan
A
Alhan
Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey.
Unal
U
Sakinci
D000328:Adult; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000379:methods*; D012189:Retrospective Studies; D013899:Thoracic Neoplasms / Q000150:complications / Q000175:diagnosis*; D035441:Thoracic Wall / Q000000981:diagnostic imaging*; D013991:Tietze's Syndrome / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult