1/21. Anterior chest wall pain in postpartum costochondritis. Costochondritis is a common diagnosis in patients with anterior chest wall pain in whom serious disease has been excluded. The diagnosis is usually made on clinical grounds, because laboratory and imaging investigations usually provide little information. The authors describe a young woman with postpartum costochondritis and discuss the role of bone scintigraphy in confirming the clinical diagnosis. ( info) |
2/21. Acute pan-costochondritis demonstrated by gallium scintigraphy. Costochondral inflammation is a rare clinical finding. A case is presented, in which acute chostochondritis is demonstrated by gallium scinitigraphy. ( info) |
3/21. Pleomorphic T-cell lymphoma with chondropathia tuberosa; a case report and review. Pleomorphic T-cell-lymphoma (anaplastic IgA-plasma cell tumor) belongs to the group of malignant non-Hodgkin's lymphomas (NHL). The histological and immunophenotypical subtypes differ with genetic and environmental etiologic factors. Lymphomas arise from the clonal proliferation of precursor cells within lymphoid organs with acquired chromosomal abnormalities. Approximately 5% of all primary malignant bone tumors are NHL, the majority of diffuse large B-cell type. Our case history can be regarded as the first published in English language reporting on a pleomorphic T-cell-lymphoma imitating a Chondropathia tuberosa (tietze's syndrome): The tumor appeared with a tender tumescence over the sternum and a painful swollen left sterno-clavicular joint--as a rule a typical sign for tietze's syndrome. Only sternal puncture followed by immune histology confirmed an anaplastic IgA-plasma cell tumor. The primary tumor, and later on an osteolysis of cervical vertebrae I-III with a complete destruction of the axis and an affection of the dens atlantis could not be detected by radiographic examinations. Moreover, this tumor infestation could only be depicted by the magnet resonance imaging and the computed tomography. Furthermore, other results of our report are the very rare manifestation of a T-cell lymphoma as a pedicled tumor near the pancreas or of pancreatic origin and the excellent result of an autologous stem cell transplantation. Reviewing the literature, we want to discuss the present scientific and clinical standards of diagnosis, progress and treatment of Chondropathia tuberosa and T-cell lymphoma, and we want to point out some new aspects of both diseases. ( info) |
4/21. Primary costochondritis due to escherichia coli. We present a case of primary costochondritis by escherichia coli, in a diabetic woman. The patient suffered a urinary infection by E. coli which may have been the source of haematogenous spread. She received medical and surgical therapy and 5 months later, she was asymptomatic. ( info) |
5/21. Malignant tumor with chest wall pain mimicking tietze's syndrome. chest pain is commonly caused by musculoskeletal chest wall disorders. tietze's syndrome is a relatively rare cause of chest wall pain characterised by non-suppurative, painful swelling of the upper costal cartilages. The diagnosis should be based on these classic clinical features after excluding other potential causes of pain. A patient who was diagnosed with tietze's syndrome but was found to have squamous cell carcinoma of the mediastinum with unknown primary site invading the sternum and anterior chest wall is presented for discussion. ( info) |
6/21. Musculoskeletal causes of chest pain. BACKGROUND: chest pain is a common presenting problem to general practitioners and accident and emergency departments. Such a symptom generates anxiety in both patients and their medical attendants, for fear that this symptom represents a life threatening event. Numerous investigations often ensue, adding to the physical and financial burden on an already stressed health system. Musculoskeletal causes of chest pain are common but frequently overlooked. OBJECTIVE: This article aims to outline some of the more common musculoskeletal problems which may present as chest pain, and to present a practical approach to their diagnosis and management. DISCUSSION: It is estimated that somewhere in the vicinity of 20-25% of noncardiac chest pain has a musculoskeletal basis. Careful history taking to identify red flag conditions differentiates those who require further investigation. Historical features suggesting a musculoskeletal cause include pain on specific postures or physical activities. A musculoskeletal diagnosis can usually be confirmed by clinical examination alone, the key to which is reproducing the patient's pain by either a movement or more specifically palpation over the structure that is the source of the pain. Confirming the diagnosis, explanation and reassurance allay anxiety. Management strategies include manual therapy, the provision of analgesia and anti-inflammatory agents, either topically, orally or by injection. Focal injection of local anaesthetic alone may also be a useful diagnostic and therapeutic tool. ( info) |
7/21. Relapsing polychondritis--a report on two Chinese patients with severe costal chondritis. Relapsing polychondritis is a rare multisystemic connective tissue disorder found mainly in Caucasians. Oriental patients with relapsing polychondritis are uncommon. We report 2 Chinese patients with relapsing polychondritis who had severe laryngotracheal narrowing requiring tracheostomy. Unlike most patients, there was marked costal chondritis resulting in depression of the anterior chest wall with minimal involvement of other joints. One of the patients had treatment with prednisolone, dapsone, azathioprine, cyclophosphamide and cyclosporin A at various stages of the disease without significant remission of the disease. ( info) |
8/21. Scintigraphic and CT findings of tietze's syndrome: report of a case and review of the literature. A case of tietze's syndrome is reported. A 43-year-old woman, who had experienced right anterior chest pain and tender swelling of the right first costosternal junction for seven months, showed increased accumulation of the right first, the right fourth, and the left first costochondral junction on bone imaging. Ga-67 imaging showed increased accumulation at the right first costosternal junction. CT showed sclerosis of the sternal manubrium, partial calcification of costal cartilage, and soft tissue swelling. biopsy of the right first costal cartilage showed chronic inflammation with fibrosis and ossification. Increased uptake of bone gallium imaging is consistent with tietze's syndrome. ( info) |
| tietze's syndrome is characterized by pain due to a self-limiting, localized, non-suppurative swelling of the costochondral or sternoclavicular junction of unknown etiology. The case of a woman is presented here who was submitted to the hospital under the suspicion of a pathological fracture. After extensive investigations the diagnosis of tietze's syndrome was made by exclusion, and the patient was successfully treated with local injection of an anaesthetic. Possible differential diagnoses of tietze's syndrome include myocardial infarction, pneumonia, and others. This report emphasizes the importance of a thorough clinical investigation and the need for the exclusion of severe and lifethreatening diseases. ( info) |
| The clinical entity of tietze's syndrome is well known. It is benign in nature, self-limiting, and of unknown etiology. Computed tomography has proved most helpful in the initial evaluation of this disorder, especially as roentgenographic plain films have been essentially noncontributory in the past. A case of this disorder was followed up over the course of 2 months, and the clinical and computed tomography findings were correlated. The authors believe that computed tomography is the most exact and reliable modality for the follow-up evaluation of patients with tietze's syndrome. ( info) |