Tietze’s syndrome–a painful disorder of the costal cartilage–can mimic a heart attack, pulmonary blood clots, or even psychological stress. Diagnosing the disorder is often a matter of ruling out what disorders a patient doesn’t have, and reaching a diagnosis by exclusion. Depending on which expert you speak to, the recommendation for the best diagnostic tool vary wildly from Xeroradiographs to CT scans. However a new study suggests that the only way to diagnose Tietze’s syndrome is to use X-ray, CT, MRI and nuclear medicine in combination as the only way to diagnose the disease.
In a May 2009 article in Clinical and Experimental Rheumatology, a team of Italian researchers described how they evaluated 30 patients with rheumatologic disorders of the sternocostoclavicular joint. These included Tietze syndrome, SAPHO syndrome, and a variety of other costal cartilage related ailments. The researchers compared CT, MRI and bone scintigraphy for all patients and found that each technique painted only a partial picture. Radiography showed sclerosis of the clavicula in only eight patients and sclerosis of the sternum in three. The CT exam fared slightly better at thirteen patients, but showed corticol bone erosions in over three-quarters of patients. The MRI was sensitive to showing soft tissue swelling in over half the patients. There were varying degrees of success with techniques showing joint space narrowing, bone erosion, and ligament ossification.
The researchers concluded that diagnosing Tietze’s disease and other rheumatic disorders of the sterno-costoclavicular joint presents a difficult diagnostic picture. One technique, say the researchers, isn’t enough to firmly diagnose a condition. They suggest that all available techniques be used in combination–X-ray, CT, MRI and nuclear medicine.
It’s hard enough to get my health insurance plan to pay for an MRI. I wonder what they will make of four diagnostic techniques at the same time…
S. Kenrose. Tietze’s Syndrome: Causes, Tests and Treatments, 2009.
Guglielmi G, Cascavilla A, Scalzo G, Salaffi F, Grassi W. Imaging of sternocostoclavicular joint in spondyloarthropaties and other rheumatic conditions. Clin Exp Rheumatol. 2009 May-Jun;27(3):402-8.