Painful chestwall swellings: tietze syndrome or chest wall tumor?
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Objective Tietze syndrome (TS) is an inflammatory condition characterized by chestpain and swelling of costochondral junction. Primary chest wall tumors maymimic TS. Inthis article, we report our experience of approximately 121 patients initially diagnosedas 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 clinicalexamination, chest X-ray, electrocardiogram, routine laboratory tests, and computedtomography (CT) of chest: all treated and followed up between March 2001 andJuly 2012. There were 121 cases (41males 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 haddoubled during the follow-up period (mean, 8.51 2.15 months). These patients werereevaluated with chest CT and bone scintigraphy and then early diagnostic biopsy wasperformed. 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% indetection of tumors (kappa: 0.56, p ¼ 0.002), whereas the sensitivity and the specificityof bone scan were 84.6 and 35.7%, respectively (kappa: 0.199, p ¼ 0.385).Conclusion Primary chest wall tumors could mimic TS. Bone scintigraphy or CT is notspecific enough to determine malignant and other benign disorders of costochondraljunction. Therefore, clinicians should follow TS patients more closely, and in case ofincreasing size of swelling, early diagnostic biopsy should be considered.
- Tıp Fakültesi Koleksiyonu