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Thorac Cardiovasc Surg 2016; 64(03): 239-244
DOI: 10.1055/s-0035-1545261
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

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

Tevfik Kaplan
1   Department of Thoracic Surgery, Ufuk University School of Medicine, Ankara, Turkey
,
Nesimi Gunal
2   Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey
,
Gultekin Gulbahar
3   Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
,
Bulent Kocer
3   Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
,
Serdar Han
1   Department of Thoracic Surgery, Ufuk University School of Medicine, Ankara, Turkey
,
Mehmet Ali Eryazgan
3   Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
,
Arzu Ozsoy
4   Department of Radiology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
,
Seniha Naldoken
5   Department of Nuclear Medicine, Ankara Numune Teaching And Research Hospital, Ankara, Turkey
,
Aslıhan Alhan
6   Department of Statistics, Ufuk University Faculty of Arts and Science, Ankara, Turkey
,
Unal Sakinci
3   Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

10 July 2014

09 December 2014

Publication Date:
05 March 2015 (online)

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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
 

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