Ribs / Chest Wall
Tietze Syndrome
티에체 증후군
Costochondritis variant with localized non-suppurative swelling
- How common
- Uncommon
- Typical age
- Ages 20–40
What is it?
Non-suppurative inflammation of upper costal cartilage producing focal cartilage thickening and swelling — self-limiting.
Commonly affected: Typically single site — 2nd or 3rd costal cartilage
How it develops
- Repetitive Cough/TraumaChronic cough or minor trauma triggers
- Perichondral InflammationPerichondrium vasodilation and edema
- Cartilage ThickeningVisible focal cartilage enlargement
- Gradual ResolutionSwelling recedes over months
Symptoms
- Tenderness to palpationTender to palpation over swelling
- Localized swellingVisible cartilage enlargement
- Anterior chest painPain over swollen area
- Worse with breathing/motionWorse with deep breath or upper body motion
- Normal overlying skinNo erythema or warmth — distinguishes from infection
How it is examined
- Visible swellingFocal prominent cartilage (single site)
- Fusiform enlargementSpindle-shaped swelling along cartilage
- Focal tendernessDirect pressure on swelling elicits pain
- No systemic inflammationNo fever; CRP/ESR usually normal
Imaging
Plain X-ray usually normal; diagnosis is clinical, imaging to exclude alternatives.
- Normal or mild soft tissue swelling
- No bony involvement
- Rule out tumor/infection
MRI shows gadolinium enhancement and edema at affected cartilage; US shows hypoechoic swelling.
- T2 hyperintensity/edema at cartilage
- Gadolinium enhancement
- US: hypoechoic cartilage thickening
Non-surgical care
- ReassuranceExplain benign self-limiting nature
- NSAIDsInflammation/pain control for 4–6 weeks
- Activity modificationAvoid triggers; rest upper body
- Heat therapyWarm compress for symptom relief
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Refractory to conservative care
Procedures that may be discussed
- Local corticosteroid injection
- Local lidocaine injection
Outlook
Pain resolves in weeks; swelling may persist for months.