Tietze syndrome
Description
Tietze’s syndrome, a painful, benign, nonsuppurative swelling of the costochondral or the sternoclavicular junction. Idiopathic benign inflammation of one or more of the costal cartilages
History of Tietze syndrome
1921 – Alexander Tietze (1864-1927) reported 4 cases observed by him in Germany in the immediate post-war period. Three were females, one male aged between 28 and 50 years. He described a swelling of the costal cartilages of unknown aetiology, insidious in its onset, spontaneously painful, not associated with constitutional disturbance, and of prolonged, fluctuating course. One case was followed for over a year, and no signs of suppuration developed.
The lesions were described as firm and were confined to the cartilages, which appeared to be expanded locally. The skin over them was normal and freely movable.
In discussing the aetiology Tietze tentatively suggested that the condition represented a dystrophic change in the cartilage analogous to the bone disease of nutritional origin which was prevalent in Germany in the early 1920’s
Original
English
Augenblicklich befinden sich in meiner Privatbehandlung drei Damen im Alter von 28, 42, und 50 Jahren, welche alle drei ein fast genau übereinstimmendes Krankheitsbild darbieten… Bei allen drei Damen hat sich im Laufe von einigen Monaten eine schmerzhafte Anschwellung der Gegend der oberen Rippenknorpel entwickelt, bei allen dreien auf der linken Brustseite.
Wir haben natürlich Röntgenbilder gemacht. Hier lässt sich ganz einwandfrei feststellen, dass der Knorpel der 1. Rippe gefasert, unregelmässig gestaltet, und anscheinend durch Kalkeinlagerungen verdichtet ist.
(Es) wurde eine Probeexzision vorgenommen. Prof. Hauser berichtet: histologische Untersuchung ergab Knorpelgewebe, dessen unregelmässige Anordnung für Tumorbildung spricht; für Malignität keine Anhaltspunkte.
In letzter Zeit sehr abgemagert, Ernährung in den Kriegsjahren der allgemeinen Lebenhaltung entsprechend. In letzter Zeit könne sie schlecht atmen, “es sei ihr als ob sie Asthma hätte, sie müsse immer so tief Luft holen.”
Ich stelle mir die Sache so vor, dass es sich um Ernährungsstörungen im Knorpel handelt, die zu Zerfaserungen und Kalkeinlagerungen führen und von reaktiven Schwellungen der Nachbarschaft begleitet sind.
Currently there are three women under my private care aged 28, 42, and 50, all of which present a near identical clinical picture. All three women have developed a painful swelling over the area of the upper costal cartilages on the left hand side, over the course of several months…
Naturally we took Röntgen pictures. Here one may easily note, that the cartilage of the 1st rib is stranded, irregular, and apparently thickened by calcium deposits
An excision biopsy was taken. Prof. Hanser reports: the histological examination demonstrates cartilaginous tissue, in irregular arrangement suggesting neoplasm, but without signs of malignancy, and showing patchy areas of calcium deposit and dissolution into fibres.
In recent time very cachectic – her nutrition during the years of war corresponding to the general living conditions. Recently she could breathe so badly, it was “as if she had Asthma, such deep breaths she had to take.”
I imagine the thing as such, that there are nutritional disturbances in the cartilage, which lead to stranding and calcifications, and are accompanied by reactive swellings in the neighbouring region
1921 – Fröhlich reported an additional case on 14 November 1921 at the Breslauer Chirurgischen Gesellschaft and published in the Berliner klinische Wochenschrift. The case was reviewed by Tietze, Küttner and Kaposi…
Original
Tab Title
d) Rippenknorpelerkrankung. 25jährige Patientin, bei der seit einem Jahre schmerzhafte Verdickungen an den Rippenknorpeler rechten 2-5 Rippe finden. Tuberkulöse Belastung. Früher spitzenkatarrh. Lungen suspekt auf Tuberkulose. Resektion der stärksten vorspringenden 4. Rippenknorpels, der eine Delle in der hat. Keine Anhaltspunkte für Tuberkulose. Röntgenbild: Verkalk im Knorpel. Ursache der Erkrankung unklar. Hinweis auf Tietze. (B. kl.W., 1921, Nr. 30.)
Hr. Küttner hat mehrfach ätiologisch unklare, schmerzhafte Auftreibungen eines einzelnen Rippenknorpels gesehen, besonders an den oberen Rippen und bei Frauen, bat aber nur einmal bei einem 26jährigen Mädchen operativ eingegriffen. Die mikroskopische Untersuchung ergab an dem exstirpierten Rippenknorpel keine blastomatöse Wucherung. In den anhängenden Weichteilen wurden Knötchen aus Fibroblasten nachgewiesen, die eine zum Teil enorme Menge von Riesenzellen in der Form der Fremdkörper-Riesenzellen enthielten. Prof. Henke schloss Tuberkulose oder Riesenzelleosarkom aus und diagnostizierte eine einfache granulierende Entzündung.
d) Rib cartilage disease. 25-year-old patient who has had painful swellings on the costal cartilage on the right 2-5 ribs for a year. Tubercular burden. Formerly acute catarrh. Lungs suspicious of tuberculosis. Resection of the strongest protruding 4th costal cartilage that has a dent in it. No evidence of tuberculosis. X-ray: calcification in the cartilage. The cause of the disease is unclear. Reference to Tietze. (B. kl.W., 1921, No. 30.)
Mr. Küttner has repeatedly seen aetiologically unclear, painful swellings of a single costal cartilage, especially on the upper ribs and in women, but only asked for surgery to be performed once on a 26-year-old girl. Microscopic examination revealed no blastomatous growth on the extirpated costal cartilage. In the attached soft tissues, fibroblast nodules were detected, which contained a sometimes enormous amount of giant cells in the form of foreign body giant cells. Prof. Henke ruled out tuberculosis or giant cell sarcoma and diagnosed a simple granulating inflammation.
1923 – Harttung described a very similar case which he also had seen in 1921. Radiographs disclosed no changes, but biopsy of part of the diseased cartilage revealed calcification and fibrosis.
Original
English
Im Anschluß an eine Arbeit von Tietze…wird über einen solchen Fall bei einem 24 jährigen Manne berichtet. Im Bereich des linken 1.—4. und 7. und 8. Rippeeknorpels fand sich eine Vorwölbung von derber und harter Konsistenz, die den Rippenknoselbet angehört. Außer einer walnußgroßen Hilusdrüse rechts ergibt die Untersuchung sonst nichts Krankhaftes. Genau wie in den Fällen von Tietze zeigen sich Schwankungen im Krankheitsbild, das wohl als Folge einer frühzeitigen Ossification angesehen werden mub, bei welcher der Anbau von Knochengewebe schneller vor sich geht als der Abbau von Knorpel ewebe.
Harttung, 1923
Following a work by Tietze … such a case is reported in a 24-year-old man. In the area of the left 1st to 4th and 7th and 8th costal cartilage there was a protrusion of coarse and hard consistency, which belongs to the costal dome. Apart from a walnut-sized hilar gland on the right, the examination reveals nothing else to be abnormal. Just as in Tietze’s cases, there are fluctuations in the clinical picture, which must probably be viewed as a result of early ossification, in which the cultivation of bone tissue proceeds faster than the breakdown of cartilage tissue.
Harttung, 1923
1937 – Satani and Fujii reported 9 cases of Tietze’s disease occurring in under-nourished women. nRadiographs showed in one case atrophy of the rib cartilage, and in another shortening of the rib and calcification of the cartilage; in all other cases radiology revealed no abnormality. Biopsy in these cases revealed fibrosis, ossification, and atrophy, there being neither granulation tissue nor pus.
1942 – Gill, Jones and Pollack reported in the British Medical Journal five cases, one with biopsy, and pointed out for the first time, the association with respiratory tract infection. Obvious malnutrition was not a factor in these cases, but the authors state, “Qualitative changes of which we are ignorant may be of etiological significance.”
An account is given of a syndrome first described by Tietze in which non-suppurative non-specific swellings appear affecting rib cartilage, and 5 cases are added to the 16 already recorded. The association with respiratory tract infections has not previously been noted.
Gill, Jones and Pollack 1942
1945 – AK Geddes reported on 22 cases of non-suppurative, non-specific swelling of the rib cartilages, a condition they described as “receiving very little attention in the literature but which in the writer’s experience is by no means rare in the Canadian Army“.
Associated Persons
- Alexander Tietze (1864-1927)
Alternative names
- Costochondral junction syndrome
- Chondropathia tuberosa
- Tietze-Syndrom
- Tietze’s Disease, Tietze’s Disease
References
Historical articles
- Tietze A. Über eine eigenartige Häufung von Fällen mit Dystrophie der Rippenknorpel. [About a peculiar accumulation of cases with dystrophy of costal cartilage] Berliner klinische Wochenschrift. 1921; 58(2): 829-831
- Frohlich. Rippenknorpelerkrankung: Breslauer Chirurgischen Gesellschaft. In: Berliner klinische Wochenschrift. 1921; 58(2): 1544-1545
- Harttung H. Über eine eigenartige Rippenknorpelerkrankung. Zentralblatt für Chirurgie 1923; 50(9): 333-336.
- Davies-Colley R. Some Affections of Ribs, Guy’s Hospital Gazette. 1927; 41: 290-293
- Satani H, Fujii S. Über 9 Fälle von Tietze’scher Krankheit, Mitteilungen aus der Medizinischen Akademie zu Kioto. 1937; 21: 1716
Eponymous terms review
- Gill AM, Arden R, Pollak L. Tietze’s Disease. Br Med J. 1942 Aug 8;2(4257):155-6.
- Geddes AK. Tietze’s Syndrome. Can Med Assoc J. 1945 Dec;53(6):571-3.
- Benson EH, Zavala DC. Importance of the costochondral syndrome in evaluation of chest pain: report of sixty-two cases. J Am Med Assoc. 1954 Nov 27;156(13):1244-6.
- Wehrmacher WH. Significance of Tietze’s Syndrome in Differential Diagnosis of Chest Pain. JAMA 1955; 157: 505-507
- Frey GH. Tietze’s syndrome; a new entity in the differential diagnosis of anterior chest wall swelling. AMA Arch Surg. 1956 Dec;73(6):951-4.
- Kayser HL. Tietze’s syndrome. A review of literature. Am J Med. 1956 Dec; 21(6): 982-9.
- Landon J, Malpas JS. Tietze’s Syndrome. Ann Rheum Dis. 1959 Sep; 18(3): 249–254.
- Cameron HU, Fornasier VL. Tietze’s disease. J. clin. Path., 1974, 27, 960-962
- Grodin L, Farina G. Tietze’s Syndrome in the emergency department: A rare etiology of atraumatic chest pain. Case Reports in Clinical Medicine, 2013; 2: 208-210.
- Mott T, Jones G, Roman K. Costochondritis: Rapid Evidence Review. Am Fam Physician. 2021 Jul 1;104(1):73-78.
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