Swelling of chest wall: Costochondritis – Symptoms and causes
A patient presenting painful chest wall swelling: Tietze syndrome
World J Emerg Med. 2019; 10(2): 122–124.
Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
Received 2018 Mar 15; Accepted 2018 Aug 20.
Copyright : © 2019 World Journal of Emergency MedicineThis article has been cited by other articles in PMC.
Patients frequently visit the emergency room with acute chest pain. While some potentially life-threatening disorders may cause the pain, in approximately 80% of cases, the chest pain source is benign, and musculoskeletal chest pain accounts for nearly 20%–50% of those cases.[1–6] Thus, pain caused by benign and pathological conditions of the chest wall encountered in the emergency department is sometimes incorrectly attributed to angina pectoris or pleuritic and other serious cardiopulmonary diseases.
Tietze syndrome is an inflammatory ailment characterized by chest pain and costochondral junction swelling with unknown cause. Tietze first described the syndrome in 1921 as a non-suppurative, benign, painful superior chondrosternal joint swelling. We report a case of Tietze syndrome in a 41-year-old male experiencing acute chest pain. Pain caused by this disease is frequently referred to the emergency department and occasionally misdiagnosed as pleurisy, angina pectoris, or other severe cardiopulmonary disorders. Our report may help raise awareness of the clinical presentation and the management of this disease among emergency physicians. Emergency physicians must be aware that musculoskeletal chest pain causes are frequent but often overlooked.
A 41-year-old man without traumatic episode presented to our emergency room complaining of acute-onset anterior chest pain. His past medical history was unremarkable without diabetes mellitus, but the patient reported smoking and alcohol consumption on a regular basis. The patient stated that the severe pain felt like a stabbing knife and was unlike any pain experienced before.
On physical examination, his temperature was 36.4 °C, blood pressure 134/73 mmHg, pulse rate 78 beats/minute, and oxygen saturation 99% on room air. He was oriented and coherent in conversation. The patient had swelling of the third chondrosternal joints and tenderness on palpation. Initial electrocardiogram was normal without ST-segment elevation or depression. No arrhythmia or abnormal T-wave change was detected. His laboratory data was unremarkable and his white blood cell count and serum troponin level were normal. Radiographs were examined to rule out pulmonary and cardiovascular causes and were found to be normal. Chest computed tomography (CT) showed minimal focal enlargement of the left second chondrosternal joint without fracture (). Based on clinical and radiological findings, Tietze syndrome was diagnosed. A non-steroidal anti-inflammatory drug (NSAID) was administered. After a few days, the NSAID relieved the pain. Twelve months after the first visit, the patient no longer experienced chest pain during exertion or rest, and restriction of joint movement and swelling over the chondrosternal joints were gone.
The patient had swelling of the second chondrosternal joints and tenderness on palpation (black arrow, left upper panel). Chest computed tomography (CT) showed minimal focal enlargement of the right second chondrosternal joint without fracture (white arrow).
Tietze syndrome usually presents in both male and female adults under the age of 40. The source of this condition is not known. No causal link has been found between Tietze syndrome and occupation, geography, or ethnicity; however, there have been clustered cases. Results of the few pathological studies conducted vary from no unusual findings to degradation and swelling of the costal cartilage with associated minimal inflammation of the perichondrium.
One differential diagnosis for Tietze syndrome is costochondritis, a more common condition characterized by tenderness and pain of the chondrosternal joints without swelling. The term costochondritis is used interchangeably with costosternal syndrome and chest wall syndrome, and definitions are not consistent. These syndromes are all characterized by pain and local tenderness at the costochondral or chondrosternal articulations, or even at the xiphoid process, but without the inflammation and swelling seen in Tietze syndrome. Many patients are left untreated and undiagnosed, possibly leading to further unnecessary examinations or cost.
Diagnosis is a clinical one, as there are no characteristic laboratory or radiographic findings. Full characterization of the chest pain is needed regarding site, onset, radiation, and exacerbating and relieving factors. Reproducible chest wall tenderness helps to rule out acute coronary syndrome in patients with acute chest pain in an early stage of the evaluation process. Manual palpation of pain and motion of muscles and joints of the chest wall and cervicothoracic spine are important; however, pain localization does not help with differential diagnosis, since pain localization of acute coronary disease does not differ from that experienced by patients with chest wall syndrome, gastroesophageal reflux disease, or psychogenic chest pain. Interestingly, one study showed that the final diagnosis in patients presenting acute chest pain in the emergency room were chest wall syndrome in 46. 6%, acute coronary disease in 14.8%, and psychogenic disorders in 9.5%. Gastroesophageal reflux disease and hypertension were seen in 3.5% and 4.0% of the patients with chest pain, respectively.
Thus, this diagnosis of Tietze syndrome is based on ruling out other possibly life-threatening health issues affecting the chondrosternal joints, such as tumors and pyogenic and rheumatoid arthritis, after careful case history, physical exam, and test results analysis. Obviously, acute injuries or trauma including rib contusion or fracture and muscular strains should be excluded. Physicians can confirm a musculoskeletal diagnosis using clinical examination alone, an important part of which is reproducing the pain by movement or palpation over the pain-originating structure. Differential diagnosis between Tietze syndrome and chest wall tumors is often difficult, especially in a patient with a history of malignant disease that frequently metastasizes to the bone. CT or bone scintigraphy is not specific enough to confirm malignant or other benign costochondral junction disorders. A report of a patient with Tietze’s syndrome and squamous cell carcinoma of the mediastinum with unknown primary site invading the anterior chest wall and sternum has been published. Clinicians should more closely follow patients with Tietze syndrome and should consider early diagnostic biopsy in cases of increasing swelling size. Treatment strategies comprise manual therapy and administration of anti-inflammatory agents and analgesics either orally, topically, or by injection. Focal local anesthetic injection alone may also be a useful therapeutic and diagnostic tool. As mentioned above, careful follow-up is critical.
Chest wall syndrome constitutes the most common etiology of chest pain seen in primary care. Emergency physicians must be aware of the management and clinical presentation of Tietze syndrome to avoid further unnecessary anxiety, time, and expense.
Ethical approval: Not needed.
Conflicts of interest: The authors declare that there are no conflicts of interest regarding the publication of this paper.
Contributors: KS proposed the study, analyzed the data and wrote the first drafts. All authors contributed to the design and interpretation of the study and to further drafts.
1. Kaplan T, Gunal N, Gulbahar G, Kocer B, Han S, Eryazgan MA, et al. Painful Chest wall swellings: tietze syndrome or chest wall tumor? Thorac Cardiovasc Surg. 2016;64(3):239–44. [PubMed] [Google Scholar]2. Stochkendahl MJ, Christensen HW. Chest pain in focal musculoskeletal disorders. Med Clin North Am. 2010;94(2):259–73. [PubMed] [Google Scholar]3. Buntinx F, Knockaert D, Bruyninckx R, de Blaey N, Aerts M, Knottnerus JA, et al. Chest pain in general practice or in the hospital emergency department:is it the same? Fam Pract. 2001;18(6):586–9. [PubMed] [Google Scholar]4. Jensen S. Musculoskeletal causes of chest pain. Aust Fam Physician. 2001;30(9):834–9. [PubMed] [Google Scholar]5. Knockaert DC, Buntinx F, Stoens N, Bruyninckx R, Delooz H. Chest pain in the emergency department:the broad spectrum of causes. Eur J Emerg Med. 2002;9(1):25–30. [PubMed] [Google Scholar]6. Bosner S, Becker A, Hani MA, Keller H, Sonnichsen AC, Karatolios K, et al. Chest wall syndrome in primary care patients with chest pain:presentation, associated features and diagnosis. Fam Pract. 2010;27(4):363–9. [PubMed] [Google Scholar]7. Gijsbers E, Knaap SF. Clinical presentation and chiropractic treatment of Tietze syndrome:A 34-year-old female with left-sided chest pain. J Chiropr Med. 2011;10(1):60–3. [PMC free article] [PubMed] [Google Scholar]8. Dichter E, Espinosa J, Baird J, Lucerna A. An unusual emergency department case:ruptured ectopic pregnancy presenting as chest pain. World J Emerg Med. 2017;8(1):71–3. [PMC free article] [PubMed] [Google Scholar]9. Kamel M, Kotob H. Ultrasonographic assessment of local steroid injection in Tietze’s syndrome. Br J Rheumatol. 1997;36(5):547–50. [PubMed] [Google Scholar]10. Grani C, Senn O, Bischof M, Cippa PE, Hauffe T, Zimmerli L, et al. Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain:a prospective diagnostic study. BMJ Open. 2015;5(1):e007442. [PMC free article] [PubMed] [Google Scholar]11. Bosner S, Bonisch K, Haasenritter J, Schlegel P, Hullermeier E, Donner-Banzhoff N. Chest pain in primary care:is the localization of pain diagnostically helpful in the critical evaluation of patients?–A cross sectional study. BMC Fam Pract. 2013;14:154. [PMC free article] [PubMed] [Google Scholar]12. Wertli MM, Ruchti KB, Steurer J, Held U. Diagnostic indicators of non-cardiovascular chest pain:a systematic review and meta-analysis. BMC Med. 2013;11:239. [PMC free article] [PubMed] [Google Scholar]13. Thongngarm T, Lemos LB, Lawhon N, Harisdangkul V. Malignant tumor with chest wall pain mimicking Tietze’s syndrome. Clin Rheumatol. 2001;20(4):276–8. [PubMed] [Google Scholar]
Costochondritis: Diagnosis and Treatment – American Family Physician
1. Disla E,
Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med.
2. Fam AG.
Approach to musculoskeletal chest wall pain. Prim Care.
3. Wise CM,
Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients. Arch Phys Med Rehabil.
4. Pantell RH,
Goodman BW Jr.
Adolescent chest pain: a prospective study. Pediatrics.
5. Costochondritis. Stedman’s Online Medical Dictionary. http://www.stedmans.com/section.cfm/45. Accessed April 15, 2009.
6. Kayser HL.
Tietze’s syndrome: a review of the literature. Am J Med.
7. Zapatero J,
López Longo J,
Costal chondritis in heroin addicts: a comparative study with postsurgical chondritis. Br J Dis Chest.
8. Chicarilli ZN,
Costochondritis: pathogenesis, diagnosis, and management considerations. Plast Reconstr Surg.
9. Heckenkamp J,
Post-traumatic costochondritis caused by Candida albicans. Aetiology, diagnosis and treatment. Scand Cardiovasc J.
10. Meyer CA,
Cartilaginous disorders of the chest. Radiographics.
11. Bickley LS, Szilagyi PG. Bates’ Guide to Physical Examination and History Taking. 8th ed Philadelphia, Pa: Lippincott Williams & Wilkins. 2003.
12. Saltzman DA,
The slipping rib syndrome in children. Paediatr Anaesth.
13. Massin MM,
Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr (Phila).
14. Klinkman MS,
Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network. J Fam Pract.
15. Buntinx F,
Chest pain in general practice or in the hospital emergency department: is it the same? Fam Pract.
16. How J,
The causes of musculoskeletal chest pain in patients admitted to hospital with suspected myocardial infarction. Eur J Intern Med.
17. Spalding L,
Cause and outcome of atypical chest pain in patients admitted to hospital. J R Soc Med.
18. DynaMed. Fibromyalgia. http://www.ebscohost.com/dynamed (subscription required). Accessed April 15, 2009.
19. DynaMed. Zoster http://www.ebscohost.com/dynamed (subscription required). Accessed April 15, 2009.
20. Gregory PL,
Musculoskeletal problems of the chest wall in athletes. Sports Med.
21. Miller CD,
Is the initial diagnostic impression of “noncardiac chest pain” adequate to exclude cardiac disease? [published correction appears in Ann Emerg Med. 2005;45(1):87]. Ann Emerg Med.
22. Cayley WE Jr.
Diagnosing the cause of chest pain. Am Fam Physician.
23. Hamburg C,
Reliability of computed tomography in the initial diagnosis and follow-up evaluation of Tietze’s syndrome: case report with review of the literature. J Comput Tomogr.
24. Mendelson G,
Can (99m) technetium methylene diphosphonate bone scans objectively document costochondritis? Chest.
25. Ikehira H,
Acute pancostochondritis demonstrated by gallium scintigraphy. Br J Radiol.
26. Caruana V,
Gallium detection of Salmonella costochondritis. J Nucl Med.
Chest Wall Lumps | Rib Injury Clinic
Chest wall asymmetry (variation between one side and another) is common and often presents in childhood as a lump in the anterior chest wall. It may be related to scoliosis (curvature of the spine) presenting with a lump on the chest on the opposite side to the curvature along with uneven shoulders and/or hips. Pectus deformities – pectus excavatum and particularly pectus carinatum can present with a ‘lump’ in the anterior chest wall.
Pectus carinatum in a 14 year old boy. It developed during a rapid growth spurt over a year
Pectus Carinatum Bracing treatment – pectusclinic.com Find out more
Pectus deformities can be present at birth or within the first year, but often only become noticeable during puberty. Associated musculoskeletal abnormalities such as Marfan syndrome, Ehlers-Danlos and Poland Syndrome are common but other associated conditions include Congenital heart disease, osteogenesis imperfecta, muscular dystrophy, Pierre Robin Syndrome, Turner Syndrome, and prune belly Syndrome.
Rib Abnormalities and anatomical variations of ribs can cause an ‘apparent’ chest wall lump. One of the more common variants is Prominent Convexity of the anterior rib/s presenting at a young age. It’s important to differentiate this from a pectus carinatum deformity.
Other types of rib abnormalities presenting with an apparent chest wall lump include rib Segmentation and Fusion Anomalies leading to abnormally shaped ribs for example bifid rib, fusion or bridging between ribs or smaller (hypoplastic) or missing ribs (absent) as in Poland’s Syndrome.
Young man with Poland’s syndrome. Note missing right pectoralis muscle and upper ribs at front (red ring). When he breathes in, due to missing upper anterior ribs, chest wall draws inwards (left image, red arrow) and then when he breathes out, lung bulges outwards (right image, blue arrow)
Supernumerary or extra ribs can also be seen, the most common is cervical ribs, arising from the 7th cervical vertebrae, on one or both sides. It does not present with a chest wall lump but can cause temporary loss of feeling, weakness or tingling in the affected arm and fingers.
Diagnosis & Treatments of Chest Wall Tumors/Sarcomas | Mount Sinai
The chest wall plays an important role in keeping our organs safe. It is the bone-and-tissue framework that forms a cage around vital organs such as the heart and lungs. The chest wall includes the spine, sternum, and ribs. Many types of tumors can grow in this structure. Some are primary tumors, which originate in the chest wall; these can be either benign or malignant. Others are secondary tumors, which spread (metastasize) to the chest wall from another site in the body. When tumors metastasize, they are almost always malignant.
When a tumor forms in the bones, soft tissue, or cartilage, and is malignant, we call it a sarcoma. Malignant chest wall tumors include many types of sarcoma. Symptoms of chest wall sarcomas vary with the tumor’s classification and severity. You might experience difficulty breathing as well as pain and swelling surrounding the tumor.
Types of Chest Wall Sarcomas
The following types of sarcomas could grow in the chest wall:
- Chondrosarcoma: Forms in cartilage and is the most common type of primary chest wall bone cancer. It usually presents as a slowly enlarging, painful mass.
- Osteosarcoma: Forms in bone, typically during a period of accelerated growth, such as adolescence. It typically presents as a rapidly enlarging, painful mass.
- Ewing’s sarcoma: Forms in bone, and most often affects children and young adults. It usually presents as a painful mass with fever and fatigue.
- Plasmacytoma: Arises from plasma cells and is an isolated form of multiple myeloma. You may feel pain but not see a mass. This is one of the few chest wall tumors that we rarely treat surgically.
- Malignant fibrous histiocytoma: The most common soft tissue sarcoma, this often occurs in adults. These usually present as a slowly growing, painless mass.
- Rhabdomyosarcoma: Forms in striated muscle, and most often affects children and young adults. These usually present as a rapidly growing, painless mass.
Diagnosis and Treatment
The process of diagnosing a chest wall tumor typically begins with a physical exam, followed by an imaging test, such as an X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI). If we need additional information, we may do a biopsy. This involves taking a tissue sample from the tumor and testing it in the lab.
We design a treatment plan based on the type and stage of tumor you have. Surgical resection is the mainstay of treatment for most early stage chest wall tumors. Additional treatment can include radiation and chemotherapy.
Why Mount Sinai
At Mount Sinai, your thoracic surgeon coordinates a team of specialists to manage your disease. Our goal is to remove the entire tumor without affecting your ability to breathe. We also protect your underlying chest structures, including your heart and lungs. We strive to cure your disease while maintaining your quality of life.
Painful chest wall swelling | Postgraduate Medical Journal
A 70 year old man, a non-smoker, presented with a painful swelling over the right sternoclavicular joint and low grade continuous fever for a period of two months. The patient had been empirically started on antituberculous therapy on the suspicion of tuberculous osteomyelitis, but his fever and swelling persisted.
On clinical examination, a hard and tender swelling was present over the right sternoclavicular joint. The swelling was fixed to the underlying bone, but not to the overlying skin. The patient did not have any skin lesions. Examination of his respiratory system revealed no abnormality. Examination of other systems was unremarkable.
Blood investigations showed a haemoglobin concentration of 160 g/l. The total white blood cell count was 10. 5 × 109/l with 72% polymorphonuclear cells, 26% lymphocytes, and 2% eosinophils. ELISA testing for HIV infection was negative. Other haematological and biochemical parameters were within normal limits.
Fine needle aspiration cytology of the swelling showed a few red blood cells, polymorphonuclear cells, lymphocytes, and a few epithelioid cells in a necrotic background. No granulomas or giant cells were seen.
Computed tomography (plain and contrast) of the thorax revealed a right sternoclavicular and first costoclavicular joints arthropathy with subchondral sclerosis and abnormal periarticular soft tissue mass. A technetium-99 bone scan was done (shown in fig 1) which revealed the diagnosis.
- What does the bone scan show?
- What is the diagnosis and name the associated syndrome.
The bone scintigraphy shows an increased radiotracer uptake in the region of the right sternoclavicular joint and the manubrium sterni (“bullhead” sign). Increased uptake was also seen in the region of the left knee joint, the left ankle joint, D9 thoracic vertebrae, and the posterior end of the left eighth rib.
The diagnosis is sternocostoclavicular hyperostosis (SCCH).1 The associated syndromes are called SAPHO syndrome (an acronym for synovitis, acne, pustulosis, hyperostosis, and osteitis),1
2 CRMO (chronic recurrent multifocal osteomyelitis),1
2 ACW syndrome (anterior chest wall),2 or PAO (pustulotic arthro-osteitis).1
SCCH is observed mainly in young and middle aged adults, and is rarely seen above 60 years of age.1 Bone and joint involvement are the commonest findings. Patients present with pain and swelling of gradual onset, most commonly involving the medial end of the clavicle and the manubrium sterni. Involvement of only one clavicle and the adjacent part of the manubrium sterni are also a frequent event. The ribs are similarly involved, with changes occurring in the anterior costochondral junction and/or in the posterior costal arch, leading to limitation of the thoracic cage mobility. 1 The swelling might also present as a solitary neck mass or as thoracic sinus formation.4
5 Flat bones like the ileum, the mandible, long bones, or spine could also be involved in the disease process.1 The involved bone shows sclerotic changes with periosteal, articular, or periarticular inflammation.1
The skin involvement in SAPHO and PAO is usually in the form of palmoplantar pustulosis, palmoplantar pustular psoriasis, or severe acne known as acne conglomerata or acne fulminans. Though skin involvement is a common feature, the absence of skin lesions at the time of presentation is only apparent because the skin lesions may have been transitory, or may develop decades after the bony manifestation. The patient may have other manifestations like thoracic outlet syndrome, thrombosis of the subclavian vein, or superior vena cava syndrome.1
Diagnosis can be made by radiography. Bone scintigraphy using radiotracer material like technetium-99 is the imaging modality of choice. It reveals hot spots in the areas of increased uptake. “Bullhead” sign refers to increased uptake by the medial end of the clavicles and manubrium sterni, corresponding to a bull’s head. This sign is a typical and a highly specific manifestation of SSCH syndrome and helps to confer the diagnosis.1 Also a bone scan is able to detect early bone involvement, which would not yet be seen radiographically. Ultrasonography, computed tomography, and magnetic resonance imaging contribute little to the identification and location of the lesion.1
There are no specific markers for these syndromes. Blood counts are usually normal. A moderate increase in C reactive proteins, erythrocyte sedimentation rate, and alpha-2 and gammaglobulins may be present. Histopathological examination of the biopsied tissue shows hyperostosis. Later in the course of the disease an infiltrate of mononuclear cells, lymphocytes, plasmocytes and a few multinucleated cells may be seen.1 Various theories have been postulated regarding the aetiopathogenesis. A reactive osteomyelitis is potentially triggered by saprophytes or caused by infectious agents like Propriobacterium acne, which has been found at the site of a lesion in many cases. The link with seronegative spondylarthritis also suggests a genetic predisposition, loosely associated with HLA-B27.
The treatment involves the use of anti-inflammatory drugs. The duration of treatment has not been standardised. Corticosteroids may be used in the most severe form. Colchicine and sulphasalazine may prove to be successful.1 Thus the recognition of SCCH syndrome is essential to differentiate this benign condition from other serious involvements like bacterial osteomyelitis, infectious spondylodiscitis, Ewing’s sarcoma, and Paget’s disease.5 This can protect an individual from unnecessary therapeutic procedures and unnecessary medications.1
Sternocostoclavicular hyperostosis (SCCH) is a benign condition that involves bones and joints.
SCCH is seen in the young and middle aged, rarely in old age.
Associated syndromes include SAPHO, PAO with skin involvement.
Diagnosis is by bone scan with classical “bullhead sign”.
Treatment consists of anti-inflammatory drugs, rarely in severe cases with steroids.
SCCH should be considered in the differential diagnosis of bacterial osteomyelitis, Paget’s disease, Ewing’s sarcoma, and infectious spondylodiscitis.
Costochondritis – Physiopedia
Costochondritis is a self-limiting condition defined as painful chronic inflammation of the costochondral junctions of ribs or chondrosternal joints of the anterior chest wall.
- It is a clinical diagnosis and does not require specific diagnostic testing in the absence of concomitant cardiopulmonary symptoms or risk factors.
- Costochondritis is often confused with Tietze syndrome.
- Palpation of the affected chondrosternal joints of the chest wall elicits tenderness  and pain is reproduced by palpation of the affected cartilage segments which may radiate out into the chest wall.
Clinically Relevant Anatomy[edit | edit source]
The thoracic wall consists of the
- Sternum anteriorly,
- 12 thoracic vertebrae posteriorly,
- 12 paired ribs and associated costal cartilages.
Ribs consist of bone and cartilage, with cartilage serving as an elastic bridge between the bony portion of the rib and the sternum.
According to their attachment to the sternum, the ribs are classified into 3 groups: true, false, and floating ribs.
- True ribs are the ribs that directly articulate with the sternum with their costal cartilages – ribs 1-7. They articulate with the sternum by the sternocostal joints. The first rib is an exception to that rule; it is a synarthrosis and the first rib could uniquely articulate with the clavicle by the costoclavicular joint
- The false ribs (8,9,10) are the ribs that indirectly articulate with the sternum, as their costal cartilages connect with the seventh costal cartilage by the costochondral joint.
- The floating ribs (11,12) do not articulate with the sternum at all (distal two ribs).
The ribs move with respiration and with truncal motion or movement of the upper extremities.
Costochondritis is inflammatory. It is caused by inflammation of the costal cartilages and their sternal articulations, also known as the costochondral junctions.
Epidemiology[edit | edit source]
The epidemiology of costochondritis is not well established.
- In a small study published in 1994, there was a higher frequency of costochondritis seen in females and Hispanics.
- In a group of 122 patients presenting to the emergency department with chest pain not due to malignancy, fever, or trauma, costochondritis was the diagnosis in 36 of the patients (30%)
- Can affect children as well as adults. A study of chest pain in an outpatient adolescent clinic found that 31 percent of adolescents had musculoskeletal causes, with costochondritis accounting for 14 percent of adolescent patients with chest pain.
Characteristics/Clinical Presentation[edit | edit source]
As with any chest pain, history of present illness, past medical history, social history, family history, and a review of systems are very important. Many deadly causes of chest pain should be ruled out prior to establishing a diagnosis of costochondritis.
Possible findings include
- Patient will give a history of the pain worsening with movement and certain positions. The pain will also typically be worse when the patient takes a deep breath.
- Pain quality is variable, but it may be described as a sharp or dull pain.
- Patients report a gradual or rapid onset of pain and swelling of the upper costal cartilage of the costochondral junction.
- Pain is usually reproducible by mild-to-moderate palpation. Often, there is point tenderness where one or two ribs meet the sternum (a pitfall of the typical physical exam findings is that pain due to acute coronary syndrome can also be described as reproducible).
- Symptoms may occur gradually and can disappear spontaneously after a few days, but equally it may take years to disappear.  Even after the symptoms have resolved, they may return at the same location or at another rib level. 
- There may be hypomobility of the upper thoracic spine, costovertebral joints, and the lateral ribs.
Costochondritis is usually self-limited and benign – should be distinguished from other, more serious causes of chest pain.
- Coronary artery disease is present in 3 to 6 percent of adult patients with chest pain and chest wall tenderness to palpation.
- History and physical examination of the chest that document reproducible pain by palpation over the costal cartilages are usually all that is needed to make the diagnosis in children, adolescents, and young adults.
- Patients older than 35 years, those with a history or risk of coronary artery disease, and any patient with cardiopulmonary symptoms should have an electrocardiograph and possibly a chest radiograph.
- Consider further testing to rule out cardiac causes if clinically indicated by age or cardiac risk status
The differential diagnosis for costochondritis is rather long. Some of the diagnoses included are associated with major morbidity and mortality. eg
Patient-specific functional scale ( PSFS): specific questionnaires for costochondritis have not yet been produced, but the PSFS is a valid, reproducable, and responsive outcome measure for patients with neck pain, back pain, and upper quarter complaints 19
The Global rating of change (GROC): to measure the patient’s subjective rate of improvement.improvement .
Measurement of thoracic and cervical mobility:
- Rotation of the thoracolumbar spine (TR): TR has high validity and sensitivity ranks and improvement of the measurement technology would probably result in a superior test for the follow-up.
- Finger to floor distance (FFD): high reliability and sensitivity, but poor correlation with spinal changes
- The Schober test
- Thoracolumbar flexion
- Occiput to wall distance 
Patients with Costochondritis will present with:
- Chest pain reproducible by palpation of the affected area, with ribs 2 to 5 mostly affected.
- Aggravating factors can be slouching or exercise.
- Often occurs after a recent illness with coughing or after intense exercise and it mostly of unilateral origin.
- May be an associated restriction of the corresponding costovertebral and costotransverse on examination.
- Loss of normal spinal movement associated with the chest pain.
- Palpation should be performed with 1 digit, on the anterior, posterior, and lateral side of the chest, the clavicle, the cervical and thoracic spine. When on the affected area it reveals a reproducible pain which might suggest Costochondritis, but it cannot entirely concluded.
- Motion palpation is a manual process of moving a joint into its maximal end range of motion, after which it is challenged with a light springing movement. This end point of joint movement forms the basis for determining the normal or abnormal joint movement. When motion palpation is reduced, the joint is considered fixated or hypokinetic. 
- Cardiac causes should be ruled out in patients who present with a high risk.
Treatment consists of conservative management and is usually symptomatic, 
- Topical or oral analgesics.
- Local injections with steroid into the joint, tendon sheath or around the nerve, inhibits inflammation, reduces swelling and pain to improve movement. 
- If patients have severe or refractory costochondritis, refer for outpatient follow-up. Physical therapy is a treatment option for refractory costochondritis
- Alternative treatments may also include: ice, acupuncture, manual therapy, exercise, and other medications such as sulfasalazine which may have an additional long-term benefit in the management of costochondritis 
Physical Therapy Management[edit | edit source]
- Education – reassure the patient by explaining the condition 
- Minimising activities that provoke the symptoms (e. g. reducing the frequency or intensity of exercise or work activities)
- A course of trigger point therapy to reduce pain – eg.cross fibre friction massage
- Use heat/ cold pads and massage to help against the overloading of muscles and to lessen the pain. Heat and cold pads are both equally effective. So the patient can choose which one he likes the most. Instead of using cold pads, the patient can also use Vapocoolant spray on the involved areas. This spray can relief the pain on the chest.
- Postural exercises – Re-train proper posture in functional positions (Neuro-muscular control). Functional training is all about using the right muscles at the right time, to sustain the correct posture, in daily activities. Simple activities like eg. correct standing posture, sit to stand and walking up stairs all need be addressed to ensure correct technique and muscle recruitment.
- Thoracic manual therapies directed at the lateral and posterior rib structures to improve rib and thoracic spine mobility
- Exercises in the range of motion should be induced as soon as possible. The patient may not have pain when he is doing the exercises eg.rotation exercises for thoracic spine. Do not invoke pain.
- Progressive stretches. They can begin with simple mobility exercises as tolerated eg  Stretching of the M. pectoralis major can be helpful (stretch the M. pectoralis major, stand in a corner for 10 sec with both of your hands against the wall (like when you do a push-up)repeat it a few times a day for 1 or 2 minutes).
- Mobilisation of the spine and ribs to improve thorax mobility and to reduce symptoms. 
- On the painful area they can use transcutaneous electrical stimulation and electroacupuncture. The acupuncture needle is placed within the involved spinal segment. Than low-frequency electrical currents are applied on the inserted needle.
- Dry needling : Musculoskeletal chest wall pain has traditionally been a difficult area to evaluate and treat. Dry needling in the hands of properly trained providers may aid in diagnosis and treatment of focal chest wall syndromes
Resources for pictures:
- Fig 1 & 2 : From THIEME Atlas of Anatomy, General Anatomy and Musculoskeletal System, © Thieme 2005, Illustration by Karl Wesker
- Fig 3 : Rovetta G, Sessarego P, Monteforte P. Stretching exercises for costochondritis pain. G Ital Med Lav Ergon. Apr-Jun 2009;31(2):169-71
Costochondritis should be a diagnosis of exclusion. Rule out other causes of chest pain that are associated with increased morbidity and mortality.
- Patients typically present with chest pain worse with breathing, and it is often positional.
- Costochondritis is a self-limited disease.
- It should be reproducible on a physical exam, and the patient’s vital signs should be within normal limits. If ordered, labs, ECG, and chest x-ray should also be normal.
- Diagnosis is confirmed by a scan or bone scintigraphy and by a physical assessment of the affected costal cartilage.
- The treatment of costochondritis consists of conservative management and is usually symptomatic .
- Physiotherapy is often ordered if the condition does not respond to treatment (see physiotherapy section for details).
- ↑ https://images. onhealth.com/images/slideshow/xl-sq-promos/chest-pain-costochondritis.jpg
- ↑ 2.02.12.22.32.42.5 PROULX A and TERESA W.; Costochondritis: Diagnosis and Treatment; Am Fam Physician. 2009 Sep 15;80(6):617-620
- ↑ 3.03.1 Clemens WM. et al. ; Introduction to Chest Wall Reconstruction : Anatomy and Physiology of the Chest and Indications for Chest Wall Reconstruction ; Semin Plast Surg. ; 2011 ; 25(1) : 5-15
- ↑ Safarini OA, Bordoni B. Anatomy, Thorax, Ribs. InStatPearls [Internet] 2019 Feb 19. StatPearls Publishing.Available from:https://www.ncbi.nlm.nih.gov/books/NBK538328/ (last accessed 14.4.2020)
- ↑ 5.05.15.25.3 Schumann JA, Parente JJ. Costochondritis.Available from:https://www.ncbi.nlm.nih.gov/books/NBK532931/ (last accessed 29.4.2020)
- ↑ Fam A.G., Smythe H.A.,Musculoskeletal chest wall pain, Can Med Assoc J. Sept 19851; 133(5):379-389
- ↑ Gregory P.L., BISWAS A.C., Batt M.E.,Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002;32(4):235-50.
- ↑ Hurst J.W., Morris D.C., Williams B.R. “Chest Pain” in patients with costochondritis or Tietze’s syndrome, Wiley-Blackwell, 2001, p23-29
- ↑ 9.09.1 Han J N et al.; Respiratory function of the rib cage muscles; European Respiratory Journal ISSN 0903 1993.
- ↑ Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. American family physician. 2009 Sep 15;80(6):617-20.Available from:https://www.ncbi.nlm.nih.gov/pubmed/19817327 (last accessed 29.4.2020)
- ↑ Brian E Udermann et al.; Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report; J Athl Train. 2005 Apr-Jun; 40(2): 120–122
- ↑ Brenda M. Birmann et al.; Prediagnosis biomarkers of insulin-like growth factor-1, insulin, and interleukin-6 dysregulation and multiple myeloma risk in the Multiple Myeloma Cohort Consortium. Blood. 2012 Dec 13; 120(25): 4929–4937.
- ↑ FREESTON J; Can Early Diagnosis and Management of Costochondritis Reduce Acute Chest Pain Admissions?; The Journal of Rheumatology November 2004, 31 (11) 2269-2271
- ↑ Viitanena J, H. Kautiainena, J. Sunia, M. L. Kokkoa & K. Lehtinena; The Relative Value of Spinal and Thoracic Mobility Measurements in Ankylosing Spondylitis; Scandinavian Journal of Rheumatology; Volume 24, 1995 – Issue 2
- ↑ 15.015.1 Aspegren D; Conservative Treatment of a Female Collegiate Volleyball Player with Costochondritis ; Journal of Manipulative and Physiological Therapeutics ; May 2007 Volume 30, Issue 4, Pages 321–325
- ↑ 16.016.1 Grindstaff L.T. et al. ; Treatment of a female collegiate rower with costochondritis : a case report ; J Man Manip Ther. ;2010 ;18(2) : 64-68
- ↑ Kamel M. et al. ; Ultrasonographic assessement of local steroid injection in Tietze’s syndrome ; Br J Rheumatol ; 1997 ;36(5) : 547-50
- ↑ Freeston J. et al. ; Can early diagnosis and management of costochondritis reduce acute chest pain admissions ?; J Rheumatol ; 2004 ; 31(11)-2269-71
- ↑ Massin MM, Bourguignont A, Coremans C, Comté L, Lepage P, Gérard P. Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr 2004;43(3):231-238
- ↑ 20.020.120.2 Hudes K, Low-tech rehabilitation and management of a 64 year old male patient with acute idiopathic onset of costochondritis. J Can Chiropr Assoc. 2008 December; 52(4): 224–228
- ↑ Rovetta G, Sessarego P, Monteforte P. Stretching exercises for costochondritis pain. G Ital Med Lav Ergon. Apr-Jun 2009;31(2):169-71
- ↑ Buntinx F, Knockaert D, Bruyninckx R, et al. Chest pain in general practice or in the hospital emergency department: is it the same? Fam Pract. 2001;18(6):586-589.
- ↑ Imamura ST., et al., syndrome de tietze, Cossermeli W., Terapêutica em reumatologia, Sao Paulo, lemos editorial, p773-777, 2000.
- ↑ Richard B, Westrick P., Evaluation and treatment of musculoskeletal chest wall pain in military athlete. The International Journal of Sports Physical Therapy, 2012, Volume 7(3) Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362990/ (last accessed 30.4.2020)
Chest Wall Pain – Comprehensive Pain Phyicians – Doctors Ajakwe and Tatevossian
What is Chest Wall Pain?
Chest wall pain (Costochondritis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). Pain caused by costochondritis may mimic that of a heart attack or other heart conditions.
What are the Symptoms?
Chest pain associated with costochondritis is usually occurs after exercise, minor trauma, or an upper respiratory infection.
Specific symptoms include:
- Sharp or dull pain on your front chest wall. It may radiate to your back or abdomen and is more common on your left side.
- Pain with a deep breath or cough.
- Pain in 4th, 5th and 6th ribs that increases as you move your trunk or take deep breaths. Conversely, it decreases as your movement stops or with quiet breathing.
- Reproducible tenderness when pressing on the rib joints (costochondral junctions). Without this tenderness, a diagnosis of costochondritis is unlikely.
- When costochondritis occurs as a result of infection after surgery, you will see redness, swelling, or pus discharge at the site of the surgery.
Comparison to Tietze Syndrome
A related condition, tietze syndrome, typically exhibits swelling at the rib-cartilage junction, whereas ostochondritis has no noticeable swelling. Neither condition involves pus or abscess formation.
Tietze syndrome usually affects the junctions at the second and third ribs, and the swelling may last for several months. The syndrome can develop as a complication of surgery on your sternum months to years after the operation.
What are the Treatments?
The treatments for costochondritis are painkillers and anti-inflammatory medications. Often, just simple painkillers such as paracetamol or codeine are needed.
Ibuprofen is an anti-inflammatory medication (also called a non-steroidal anti-inflammatory drug, or NSAID) that is often effective for costochondritis. Other NSAIDs are available on prescription.
For severe cases of costochondritis not responding to painkillers and anti-inflammatory medication, injections of steroids or local anaesthetic medicines may be used.
In extreme cases, an intercostal nerve block can be performed (usually by a doctor specializing in acute pain and/or anaesthetics). This involves injection of a local anaesthetic medicine around the painful ribs, to block the nearby intercostal nerve. The intercostal nerves transmit the painful sensation in costochondritis. This sort of injection temporarily disrupts nerve impulses to stop the pain. Nerve blocks can last several weeks or months. In repeated, severe cases of costochondritis, a series of these injections can be given to permanently destroy the nerve causing the pain.
Non-medicinal measures can be tried for relief of pain in costochondritis. Examples of such techniques include:
- Heat pads.
- Ice application.
- Transcutaneous electrical nerve stimulation (TENS).
- Gentle stretching exercises.
- Avoidance of sports or activities that worsen the pain.
- Physiotherapy or chiropractic therapy.
90,000 Chest cancer – symptoms and signs
Contents of the article:
Features of breast cancer
The chest is made up of many organs, including bones and soft tissues, as well as the lungs and pleura, heart and mediastinal organs (esophagus, trachea, thymus, thoracic lymphatic duct, pericardium), vessels, nerves, lymph nodes. All of them can be affected by malignant tumors. The most common type of malignant lesion of the chest cavity is lung cancer. Other types of tumors are less common and can be primary (occur directly in the chest cavity) or secondary (occur when tumors metastasize). In addition to the organs of the chest cavity, cancerous lesions can occur in the area of the pleura, diaphragm or sternum, which limit the chest cavity Source:
V.M. Karpov, A.F. Lazarev
Prevalence of multiple primary malignant neoplasms with lesions of the chest organs //
Russian Journal of Oncology, 2015, No. 5, p.53-56.
The severity, growth rate and treatment projections depend on the specific type of cancer and organ affected.
Types of oncological diseases of the chest cavity
Malignant neoplasms of the chest cavity are divided into groups:
- Lung cancer . There are several types of malignant lung lesions – non-small cell, accounting for up to 80% of all types of cancer, small cell carcinomas, adenocarcinoma, large cell carcinoma.
- Respiratory tract cancer . It includes carcinoid tumors of the respiratory tract and cystadenoid, mucoepithelioid carcinomas of the bronchi.
- Neoplasms in the mediastinum . These include malignant lesions of the intrathoracic, extrathoracic lymph nodes, esophageal cancer and thymic tumors.
- Diseases of the heart and blood vessels . Primary and metastatic cancers are possible.
- Pleural neoplasms .Especially dangerous is pleural mesothelioma and malignant fibrous tumor.
- Formations of the chest wall with damage to bones, mesenchymal tissues and cartilage . The most common malignant tumors are multiple myeloma and chondrosarcoma.
Causes of breast cancer
The exact cause of the development of different types of breast cancer has not yet been determined. There are a number of factors that increase the risk of tumor lesions in the chest.These include:
- Genetic predisposition. In families where cancer of various localization is common, the likelihood of tumors of the chest cavity is higher. This is due to the inheritance of defective genes that control cell division.
- Smoking is especially relevant for lung cancer, although it can also be found in non-smokers. Alcohol intake plays a role, especially for esophageal cancer. The joint intake of alcohol and smoking increases the risk several times.
- Poor diet and deficiency of vitamin A, zinc, molybdenum increases the risk of certain types of cancer.Being overweight and esophageal reflux increases your risk of developing esophageal cancer.
- Chronic inflammation increases the risk of developing tumors of the chest cavity, including cancers of the heart and blood vessels, lymph nodes, lungs and esophagus.
First signs, symptoms of tumors of the chest cavity
For a long time, cancers of the chest cavity do not have symptoms. As tumors grow in size, three groups of signs may appear:
- symptoms of compression of organs adjacent to the affected organs, signs of cancer growth into tissues and adjacent organs;
- common symptoms of chest cancer;
- Specific signs typical of a particular neoplasm.
For example, lesions in the mediastinal region can cause pain similar to angina pectoris. Pain may radiate to the shoulder, arm or neck, possibly impaired swallowing and breathing Source:
Saynak M, Veeramachaneni NK, Hubbs JL, Okumuş D, Marks LB
Solitary Fibrous Tumors of Chest: Look with the Oncologic Another Perspective //
Balkan Med J. 2017 May 5; 34 (3): 188-199. doi: 10.4274 / balkanmedj.2017.0350. Epub 2017 Apr 6.
Common symptoms can be identified among the key features of chest tumors:
- Development of shortness of breath on exertion or at rest;
- the appearance of a cough with phlegm, which can be stained with blood;
- pain during deep inhalation or exhalation;
- frequent bronchitis, pneumonia;
- violation of the general condition – weight loss, lack of appetite, severe weakness, nausea.
90,018 noises, wheezing when breathing;
For certain types of cancer, special symptoms are typical – dysphagia (impaired swallowing), pruritus, decreased blood glucose levels.
Diagnostics of chest cavity cancer
It is possible to detect breast cancer from the earliest stages. The medical center “CM-Clinic” is equipped with everything necessary for the fastest and most accurate diagnosis, including histological and biochemical studies in its own laboratory. Used in the diagnostic process:
- Radiography for the detection of large tumors, bone and lung lesions.The method helps to determine the affected area for more targeted research.
- MRI or CT diagnostics allows you to determine the exact size of the tumor, the involvement of adjacent structures, vessels, bones, cartilage.
- Diagnostic thoracoscopy is indicated for pleural lesions or suspected metastases, complications of lung cancer.
- Bronchoscopy is indicated for examining the bronchial tree, clarifying the localization of the tumor, taking material for histological examination.
- Various options for sputum examination in order to exclude concomitant pathologies, to identify tumor cells.
- Pleurocentesis and sampling of pleural fluid for examination (sometimes for therapeutic purposes).
- Biopsy of tumor sites, affected lymph nodes with determination of the type of cancer and its histochemical characteristics Source:
M.I. Davydov, D.G. Zaridze
Screening of malignant tumors //
Bulletin of the Federal State Budgetary Scientific Institution “Russian Oncology Center named afterN.N. Blokhin “, 2014, vol. 25, No. 3-4, p. 5-16.
Treatment of chest cancer
Based on the diagnostic data, the final diagnosis, stage of cancer, its type and specific localization are established. Patient management tactics are developed individually, taking into account age and diagnosis, comorbidities and general condition Source:
Semenova EA, Nagel R, Berns A
Origins, genetic landscape, and emerging therapies of small cell lung cancer //
Genes Dev. 2015 Jul 15; 29 (14): 1447-62.doi: 10.1101 / gad.263145.115.
If possible, surgical removal of the tumor with pre- or postoperative use of conservative techniques is used. These include:
- Chemotherapy . Before surgery, it helps to shrink the tumor to make it easier to remove. After – to suppress the remaining cancer cells.
- Targeted therapy is aimed at combating a specific type of cancer, for example, small cell lung carcinoma.
- Radiation therapy is indicated to suppress the growth of malignant cells in inoperable forms or to prepare for surgery.
Symptomatic treatment, plastic surgery is also carried out, in case of running processes, palliative therapy is indicated.
The treatment protocol for each patient is drawn up on the basis of international and domestic clinical guidelines, modern drugs and methods of surgical intervention are used that reduce the risk of side effects, which have proven efficacy with minimal possible effects on the patient’s body.
Predictions for chest cancer
With early detection of lung cancer, about 80% of patients live for more than 5 years, with other breast tumors, prognosis depends on the form of cancer and the stage of its detection. The smaller the tumor and the damage to the surrounding tissues, the higher the chances of favorable outcomes Source:
V.V. Starinsky, L.M. Alexandrova,
Lung cancer: epidemiology, prevention //
Medicine in Kuzbass, 2014, pp. 30-31.
The risk of recurrence for tumors of the chest cavity is low, for the prevention of recurrent episodes of cancer, doctors conduct long-term follow-up with follow-up examinations.
- V.M. Karpov, A.F. Lazarev. The prevalence of multiple primary malignant neoplasms with lesions of the chest organs // Russian Journal of Oncology, 2015, No. 5, pp.53-56.
- M.I. Davydov, D.G. Zaridze. Screening of malignant tumors // Bulletin of the Federal State Budgetary Scientific Institution “Russian Oncology Center named after N.N. Blokhin “, 2014, vol. 25, No. 3-4, p. 5-16.
- V.V. Starinsky, L.M. Alexandrova, O. P. Gretsova. Lung cancer: epidemiology, prevention // Medicine in Kuzbass, 2014, p. 30-31.
- Saynak M, Veeramachaneni NK, Hubbs JL, Okumuş D, Marks LB. Solitary Fibrous Tumors of Chest: Another Look with the Oncologic Perspective // Balkan Med J. 2017 May 5; 34 (3): 188-199. doi: 10.4274 / balkanmedj.2017.0350. Epub 2017 Apr 6.
- Semenova EA, Nagel R, Berns A. Origins, genetic landscape, and emerging therapies of small cell lung cancer // Genes Dev. 2015 Jul 15; 29 (14): 1447-62. doi: 10.1101 / gad.263145.115.
The information in this article is provided for reference purposes and does not replace the advice of a qualified professional.Do not self-medicate! At the first signs of the disease, you should consult a doctor.
90,000 Breast cancer – symptoms, causes, risk factors, diagnosis and treatment in medical centers “K + 31
Breast cancer is the most common cancer in women. It usually develops in the lobules of the breast (where milk is formed) or in the milk ducts. Most breast cancers are diagnosed in postmenopausal women, but women of all ages are susceptible to the disease. Breast cancer occurs in men as well, but such cases are rare.
Breast cells are characterized by rapid regeneration. A large number of new cells leads to a high risk of mutational changes in them. In addition, a change in hormonal levels during menopause or for other reasons can become a trigger for the development of pathological processes.
Factors contributing to the development of the disease
The reasons for the development of breast cancer are not yet fully understood, but the factors that can affect the appearance of cancer include:
- hereditary factor;
- early onset of menstruation and menopause;
- absence of children or late first birth;
- diseases of the reproductive system, which can lead to hormonal imbalance;
- smoking and alcohol abuse;
- multiple termination of pregnancy and history of miscarriage;
- mechanical trauma to the chest;
- high doses of radiation exposure.
Stages of breast cancer
Depending on the size and extent of the tumor, the following stages are distinguished:
- I – characterized by the size of the neoplasm, not exceeding 2 centimeters, and the absence of metastases.
- II – the tumor grows up to 5 centimeters and affects the surrounding tissues, metastases appear in the axillary lymph nodes.
- III – the size of the formation exceeds 5 centimeters, and it affects the muscle tissue, characteristic symptoms appear in the form of discharge from the nipple, swelling and “lemon peel”; multiple metastases spread to the axillary and supraclavicular lymph nodes.
- IV – the entire breast is affected, cancer spreads to the skin, affects adjacent anatomical structures, extensive ulcers and metastases appear in other organs, the tumor is motionless and attached to the chest. The stage is terminal.
Breast cancer symptoms
In the early stages, a malignant neoplasm proceeds without any pronounced signs, and can only be detected during a preventive examination.
The first warning signs of breast cancer are:
- dense painless formation in the structure of the mammary gland;
- Unaccustomed chest pain and discomfort;
- changes in the shape and shape of the mammary gland;
- change in the shape of the nipple, its enlargement, swelling, retraction;
- changes in skin turgor, for example, wrinkling;
- enlarged axillary lymph nodes on one side;
- nipple discharge.
If any of the above signs appear, seek medical attention.
A neoplasm (tumor) of the mammary gland in women is a pathological proliferation of tissue consisting of qualitatively changed breast cells.
Breast neoplasms are both benign and malignant. Up to 80% of all breast tumors are benign.Changes in the mammary gland are divided into diffuse and localized. Localized it:
- fibroadenoma – one of the forms of nodular mastopathy, consists of overgrown glandular and connective tissue, arises against the background of hormonal imbalance
- cyst – is a capsule with liquid content, located in the ducts of the mammary gland, arises against the background of hormonal imbalance
- intraductal papilloma – localized in the ducts near the nipple
- lipoma – a tumor consisting of adipose tissue
Diagnostics of breast tumors includes:
- Breast self-examination weekly
- Ultrasound of mammary glands
- MRI of mammary glands
When a tumor appears in the mammary gland, they turn to a gynecologist, mammologist, oncologist, who plan and implement treatment tactics.
Treatment of localized forms of mastopathy is successful. Formations such as fibroadenoma and intraductal papilloma are treated exclusively with a surgical method.
Diffuse forms of mastopathy are observed and treated conservatively.
Malignant neoplasm of the breast (cancer) is a fairly common pathology in women. This disease ranks second after skin cancer among oncological diseases in the world.
A distinctive feature of breast cancer is rapid aggressive tumor growth, penetration into neighboring tissues, metastasis to distant parts of the body.
The most common cause of breast cancer is hormonal changes in the body. Poor heredity, harmful environmental factors, as well as previous inflammatory diseases of the breast predispose to the development of the disease.
At the initial stages of the development of oncological disease, when examining the mammary gland, a small seal is palpated. As a rule, no other symptoms are observed. Due to the absence of symptoms in the early stages, breast cancer is most often diagnosed in an advanced form.
The oncologists of the hospital strongly recommend that you immediately undergo an examination at the first appearance of an alarm in order to make a diagnosis as early as possible and prevent a pathological process in the body. Symptoms that serve as a signal to visit a mammologist: any change in the contour and color of the mammary gland, wrinkling of the skin, retraction of the nipple, burning sensation in the gland area.
If breast cancer is detected early, it is curable. Early diagnosis of the disease consists in detecting the disease before the formation of a palpable seal in the mammary gland.At an early stage, mammography, MRI and computed tomography can detect the disease. If any abnormalities are found during the diagnosis, a puncture biopsy is performed.
Developing an individualized treatment plan is a collaborative effort between oncologists, radiologists and chemotherapists to deliver an optimistic treatment outcome.
Treatment of a malignant breast tumor is complex: surgery, chemotherapy, radiation therapy. The result of treatment depends on the timing of the detection of the tumor: the earlier the treatment is started, the more successful it is.
For early detection of breast cancer, experts recommend regular mammography, starting at the age of 40.
Pozdeev Nikolay Alexandrovich
doctor-oncologist of the highest qualification category
Smirnov Vladimir Vladimirovich
doctor-oncologist of the highest qualification category, oncourologist, Ph.D.
Maltseva Svetlana Anatolievna
Head of the Outpatient Oncological Care Center, Oncologist
Kozak Tatiana Borisovna
Ilyina Tatiana A.
90,000 Male breast cancer: causes, diagnosis, treatment
Oncology is so unpredictable that even specialists are not always ready to find answers to many people’s questions. Surprisingly, some types of cancer appear in those who are less susceptible to this pathology. What is it about? Let’s take a closer look.
Does breast cancer occur in men? This question is often asked by the strong half of humanity. Male breast cancer is ubiquitous, although less often female.
Male breast cancer is a malignant neoplasm that develops against the background of a genetic predisposition, hormonal imbalance, and an improper lifestyle.
Thanks to modern treatment methods, male breast oncology is being successfully treated today. However, for this it is necessary to consult a doctor on time and undergo a comprehensive examination of the body.
Classification of breast cancer in men
Can breast cancer in men be progressive and progressing to the development of metastases – a question that requires separate consideration. Doctors answer that the development of the disease in the male body is similar to the progression of a tumor in the female body. Based on the origin and structure, breast cancer in men is divided into the following types:
- Infiltrative ductal carcinoma. This type of tumor occurs in 80% of cases. In the process of the development of pathology, the proliferation of cancer cells in the adipose tissue occurs, which leads to the formation of metastases;
- non-invasive type of ductal cancer. Tumor growth begins with the cells of the excretory ducts of the mammary gland. This breast cancer in men is considered the safest.Metastasis in this case is rare, and the likelihood of relapse after recovery is reduced to a minimum mark;
- lobular infiltrative cancer. The growth of the tumor begins in the lobules of the mammary gland, and then goes on to adipose tissue. As it progresses, the malignant neoplasm metastasizes to nearby lymph nodes, the spine, or the lungs;
- Paget’s cancer. A type of breast cancer in men that begins to grow in the excretory ducts of the gland. As the pathology develops, the pathology passes to the areola of the breast and the nearby skin;
- edematous-infiltrative cancer. In the process of the development of pathology, the patient’s mammary glands swell and become deformed. With this type of oncology in a man, the skin on the chest is drawn in, the elasticity and shape of the glands are lost.
Modern diagnostic procedures will help determine the type of breast cancer in men. In our clinic, a complete examination of the male body is carried out.
Symptoms and signs of breast cancer in the stronger sex
In the early stages of development, the symptoms of breast cancer in men may be mild.Most often, representatives of the stronger sex perceive their banal overstrain or stretching.
Can there be breast cancer in men if there is a lump near the nipple – one of the most popular questions. Neoplasms that appear not always indicate oncology. It is necessary to sound the alarm when the following signs of breast cancer appear in men:
- nipple retraction;
- the appearance of swelling in the area of the areola;
- swelling in the chest area;
- the appearance of a lemon peel;
- peeling of the nipple.
In later stages, the patient may find an increase in the axillary and supraclavicular lymph nodes, wet ulcers with purulent expression.
Diagnosis of male breast cancer at the oncology center
In the oncology center “Sofia”, which is located at the 2nd Tverskoy-Yamskaya per. 10, carry out high-quality diagnostics of the body upon detection of symptoms of breast cancer in men.
Ultrasound of mammary glands
The procedure helps to detect the presence of a tumor in the body, to determine its size and structure, to assess the state of tissues, the presence of an inflammatory process.Ultrasound diagnostics is safe for the patient’s body.
Computed tomography is a study that allows you to illuminate the connective tissue and internal organs. The detailing of the images obtained helps to determine the presence of a tumor and metastases in the lymph nodes and internal organs.
The procedure helps to determine the presence of tumor neoplasms in the mammary glands in men. In comparison with other diagnostic studies, this method shows a more accurate result.
The procedure is performed under a local anesthetic. Biopsy involves the collection of tissue from the breast of a sick person for pathomorphological examination.
Tumor markers of breast cancer
Tumor markers are substances that appear in the patient’s body during the development of cancer. Tumor marker molecules are synthesized by the formed tumor in response to the formation of cancer pathology. These substances are used to detect malignant neoplasms in the human body.
Treatment of breast cancer in men at the oncology center
The Sofia Cancer Center uses such modern methods of breast cancer treatment as chemotherapy, fractional radiation and surgical therapy.
Chemotherapy is carried out with the help of cytostatic drugs that affect the ability to mitosis in cancer elements. This leads to a shrinkage of the tumor and the prevention of the development of metastases. Chemotherapy is fraught with adverse reactions.
Radiation therapy is used to target cancer cells.Due to this, the boundaries of the neoplasm are reduced and the formation of metastases is prevented. Radiation therapy is commonly used in the later stages of breast cancer in men.
Surgical treatment is considered one of the most radical methods of therapy. In the process, the breast, nipple and affected lymph nodes are removed.
By the decision of the doctor, combined methods of treatment, as well as coarse fractional, fractional radiation and hormonal therapy can be used.
Predictions for survival
The prognosis for timely access to a doctor for breast cancer in men is considered favorable. The probability of recovery is kept at around 85%. If pathology is detected at later stages of development due to metastases and complications, the survival rate drops to 40%. In advanced cases, death occurs.
How to make an appointment with a specialist at the Sofia Cancer Center
The Sofia Cancer Center is located in Moscow near the Mayakovskaya metro station.Address: 2nd Tverskoy-Yamskaya lane 10. To make an appointment for a consultation with an oncologist if signs of breast cancer in men are detected, you can call +7 (495) 995-00-34 or indicate your contact information in the feedback form on the website …
We employ highly qualified doctors with extensive experience. You can always come for a consultation and get answers to all your questions. Specialists carry out an operative diagnosis of the disease, and also prescribe the most optimal method of treatment.
Diagnostics of breast cancer – clinic “Family Doctor”.
The mammary gland is an organ in which tumors, both benign and malignant, develop very often, and the latter are much more common.
Among all malignant tumors in women, breast cancer occupies one of the first places. At the same time, according to the majority of modern clinical and statistical studies, the incidence of breast cancer is increasing throughout the world.
The increase in the number of patients with breast cancer cannot be attributed solely to improved early diagnosis, better registration of patients with precancerous conditions, and effective health education.
It is known that the glandular (milk) epithelium, due to neuro-endocrine influences, constantly changes during the periods of the menstrual cycle, pregnancy, menopause. In this case, the activity of the mammary gland is in close hormonal connection with the ovaries, pituitary gland, adrenal glands.The role of hormonal factors in the occurrence of breast cancer is confirmed by clinical and statistical studies. It is known that breast cancer rarely occurs before puberty, i.e. until about 18 years of age. With age, as a woman’s body ages, the incidence of cancer increases significantly. Finally, breast cancer is more common among non-pregnant and nulliparous women and women who have given birth but did not breastfeed.
The connection of hormonal disorders with the appearance in the mammary gland of various forms of benign tumors, fibrocystic mastopathy is especially noticeable.The latter, as well as fibroadenomas, are dyshormonal precancerous diseases of the breast. The frequency of degeneration of benign dyshormonal tumors into cancer, according to different authors, ranges from 0.8-1.8 to 15-52.4%. Particularly unfavorable neoplasms in this regard include nodal forms of fibrocystic mastopathy and proliferating cystadenomas.
Pathological studies show a variety of forms of breast cancer.Almost all of them, except for Paget’s cancer, arise in the thickness of the organ at different depths, more often along the outer edge of the mammary gland. Gradually increasing in size and growing, the tumor captures the surrounding tissues, primarily the nearby tissue and milk ducts. Over time, muscles, fascia, and skin are involved in the cancer process.
The growth rate of a cancerous tumor is different and depends on many factors.
In young women, tumor growth, spread and metastasis is much faster.There are 2 main directions of the nearest (regional) metastasis: axillary and retrosternal (parasternal). The first of them is the main one, since the axillary lymph nodes pass the lymph flowing from all parts of the mammary gland. Then it follows through the sub- and supraclavicular lymph nodes.
It is these listed collectors that are affected by metastases in the first place, especially when the primary cancerous tumor is localized in the outer quadrants of the mammary gland and when it is located centrally (parasilicus).Tumors growing in the inner sectors of the gland are capable of affecting parasternal lymph nodes with metastases.
There are no uniform rules or laws for metastasis. Both immediate and distant metastases can appear at any time before and after radical treatment. Distant metastases most often affect the lungs, liver, and skeletal bones. Described lesions by distant metastases of almost all, without exception, other organs and systems.
IN BREAST CANCER, in the initial period of its onset, clinical symptoms and complaints, as a rule, are absent.
Most often, a seal in the mammary gland is first discovered by chance by the patient herself or by a doctor, sometimes when examining other organs, conducting an ECG, etc.
It is necessary to take into account the presence in the past of a “bruise of the chest”, since there are many observations when the appearance of a cancerous tumor in the gland was preceded by its trauma.
IF BREAST TUMOR IS DETECTED, SEE YOUR DOCTOR IMMEDIATELY !!!
WHAT SHOULD NOT BE DONE IN NO EVENT:
Never seek advice on a breast tumor from healers, grandmothers and “religious” leaders.Such appeals often, but almost always cost human life.
Despite the abundance of information about treatment centers, now, already in the 21st century, women came to our reception, who, on the advice of, to put it mildly, ignorant people, and in legal terms, criminals brought their disease to incurable stages. Surprisingly, in 2005. turned a woman who for half a year treated a small tumor of the mammary gland with lard with kerosene on the advice of a neighbor. When she went to the doctor, all nearby lymph nodes and the spine were affected by metastases.She came only because the tumor, despite the “treatment”, became larger, and a “skin allergy” appeared on the “drug”, which, upon examination, turned out to be the involvement of the skin in the cancer process (read – 4th stage). You can’t even bring a neighbor to justice, since she is not even an illegal healer, and the woman died. It must be remembered that cancer is curable BUT if the disease is detected by a doctor at an early stage.
The Church, on the other hand, considers healing to be a godly affair and, as a rule, Orthodox priests always give blessings for surgery and treatment.If this does not happen, then, as they say, something is wrong here.
THE SYMPTOMS LISTED BELOW ARE A FURTHER OVERALL PROCESS:
PAIN – there is almost no pain in the early stages of breast cancer. In a number of cases, moderate pain appears for the first time in the axillary region, where a “packet” of dense lymph nodes is determined by palpation.
Severe pain, especially of a stabbing or pulsating nature, is more often accompanied by various benign diseases of the mammary glands, mainly of inflammatory origin.
In advanced cases of breast cancer, squeezing large nerve trunks, intense excruciating pains appear that radiate to the back, shoulder blade, and arm. The sharpest debilitating back pains are noted with metastatic lesions of the spine.
CHANGE OF THE BREAST FORM – in breast cancer, as a rule, various kinds of deformities are noted, the more pronounced, the longer and more advanced the disease. So, a decrease in size, wrinkling, blurring of the usual rounded configuration (due to the retraction area) is characteristic of the scirrosive form of cancer.In this case, the gland is shifted towards the tumor. On the contrary, in diffuse-infiltrative cancers, the affected gland is enlarged (more healthy), edematous, its configuration is disturbed, its lowering is noted below the border of the healthy gland.
SKIN CHANGE – the skin in breast cancer with cancer undergoes pronounced changes, especially with more superficially located tumors. The skin and subcutaneous tissue above the cancer node lose their elasticity and mobility, become denser, and are not so easily captured in folds.Over time, this area becomes flat at first, then acquires a fine folded wrinkle, resembling a “lemon peel” pattern.
Nipple change – changes on the side of the nipple are of a different nature; in the initial phase of tumor development, the nipple may deviate or fall on the side of the lesion. As the tumor grows, the nipple flattens and then retracts. Particular attention should be paid to the presence of bloody discharge from the nipple.
WHAT TO DO IF…
The first is to see a doctor. Many researchers point out that many women avoid breast examinations for fear of losing them.
In the early 1980s, only a quarter of women in the United States knew that their breasts could be restored after a mastectomy (removal of the breast). Today it is more widely known that modern plastic surgery can create a new breast in place of the removed one. Many women argue that if they knew more about the possibility of breast reconstruction, then most of them would be examined at an early stage.Early diagnosis improves prognosis.
Previously, it was believed that a woman should be allowed to grieve over the loss of a breast in order to better evaluate the new one, since the breast was never restored at the same time as the tumor was removed. And now it is still customary to restore the mammary gland long after surgery to remove the tumor, although studies have shown that 96.6% of women would prefer it done immediately.
WOMAN’S PSYCHE AND MALIGNANT DIAGNOSIS
The very establishment of the diagnosis: breast cancer and its subsequent removal leads to mental disorders in 96.1% of women.In the postoperative period, after removal of the mammary gland and chemotherapy behavior, social maladjustment is observed, which can be expressed in job loss or disability, family breakdown, emotional isolation, joining religious organizations, and the acquisition of addictions. Moreover, the more time passes after the removal of the mammary gland, the more these mental disorders increase.
Therefore, a one-stage operation to remove the tumor and restore the mammary gland is a means of psychological protection for a woman.
BREAST REMOVAL AND POSTURE DISORDER
After removal of the mammary gland, postural disturbance naturally occurs, and the larger the size of the remaining mammary gland, the naturally greater the load on the spine. This disorder leads to pain in the thoracic and cervical spine, often with neurological symptoms in the hands.
SELECTING THE OPERATION
Even a woman’s awareness of the possible restoration of the mammary gland at the diagnostic stage includes the mechanisms of psychological defense
Breast cancer treatment has two conflicting challenges.On the one hand, saving a life and curing a patient from a deadly disease, on the other hand, preserving an aesthetically significant organ. Therefore, the strategy should proceed from the simultaneous solution of two tasks: ensuring maximum cancer radicality and the best aesthetic result.
There are several ways to restore the mammary gland: with the help of implants and with the help of your own displaced tissues. The latter is certainly more traumatic and leaves behind additional scars on the abdomen or back.The choice of surgery in each case is strictly individual.
Since breast cancer is a systemic disease, that is, a disease affecting all organs and systems, sometimes mastectomy is not the only operation in the treatment of breast cancer. In some cases, removal of the ovaries is performed laparoscopically (i.e. without an incision). Also, without a crippling incision of the chest, we perform the removal of the retrosternal lymph nodes if they are damaged (thoracoscopic lymph node dissection).
For small breast tumors, RADICAL RESECTION is possible.
The operation consists in removing the breast sector in the same block with the subclavian-axillary-subscapularis lymph nodes.
Chemo-radiation treatment is usually done after the operation.
Depending on the location of the tumor, the size and shape of the breast, and the presence of a prior biopsy, a skin-sparing mastectomy may be performed.
The operation includes the mandatory removal of the nipple-areola complex and the removal of regional lymph nodes.
As the analysis of the socio-psychological status shows, the loss of the mammary gland is a serious psychological trauma for a woman, which has a decisive impact on her behavior in everyday life and in society. About 30% of these women cannot come to terms with the loss of the mammary gland. To overcome these problems, it is possible to perform an operation with ONE-TIME or DELAYED BREAST RECONSTRUCTION.
Early detection of breast cancer
What is breast cancer
Breast cancer (BC, breast cancer) is a malignant neoplasm (tumor) of the glandular tissue of the breast.
Prevalence of breast cancer
Worldwide, it is the most common type of cancer among women, it affects women aged 13 to 90 years. The incidence of breast cancer in developed countries has increased dramatically since the 1970s.The reason for the increase in the incidence rate is considered to be the changed lifestyle of the population of developed countries, in particular, the fact that there are fewer children in families, the timing of breastfeeding has decreased, and the age of first birth has crossed the thirty-year mark.
Considering that the mammary gland is made up of the same tissues in men and women, breast cancer sometimes occurs in men, but the incidence of breast cancer in men is less than 1% of the total number of breast cancer patients.
Breast cancer risk factors
The frequency and risk of developing breast cancer depends on many factors, both modifiable and non-modifiable.
Non-modifiable risk factors:
• Family history of breast cancer
• With previously diagnosed cancer of one breast, the risk of damage to the second breast increases
• Presence of other types of cancer (endometrial, ovarian, colon)
• First menstruation (menarche) before 11 years old
• Climax above 55 years old
Other risk factors:
• Childbirth.Women who have not given birth have a higher risk than women who have given birth.
• Delayed labor: Women whose first birth was over 30 years of age have a higher risk of developing breast cancer.
• Long-term hormone replacement therapy with estrogen-progestin drugs between the ages of 50 and 79 increases the risk of breast cancer.
• Overweight is a risk factor for postmenopausal breast cancer
• Alcohol also increases the risk of breast cancer, which is associated with increased estrogen levels with alcohol consumption.
Breast cancer screening
Breast cancer screening includes tests that detect a tumor before the woman herself finds a lump in the breast. The likelihood of dying from breast cancer declined at the end of the last century, in part because screening studies can detect cancer at an early stage, in which it is treated much more successfully.
Women at high risk of breast cancer, such as those with the BRCA1 and BRCA2 genetic mutations, who are closely related, should learn about genetic testing and screening recommendations for those at high risk.
Research for early detection of breast cancer:
• examination of the breast by a doctor
• self-examination of the breast.
• Mammography (primary screening method)
A Breast Self-Exam is a way of detecting changes in your own breast. There are no studies showing that breast self-examination reduces the risk of cancer death. However, some women feel that doing self-examinations on a regular basis improves their ability to find changes that would not otherwise be noticed.
The best time to perform a breast self-examination is about a week after the end of your period, when the breast is less stressed. If you don’t have a menstrual cycle, you can choose one day every month.
Breast examination by a doctor
Your doctor may perform breast examinations on a regular basis as part of screening. During the examination, the doctor will carefully examine and then feel both breasts and the axillary region. Most experts recommend an examination of the mammary glands, in parallel with mammography, starting from 40-50 years.
Mammography – X-ray examination of the breast. It is the best screening test for early detection of breast cancer.
Before your mammogram, you will be asked to strip to the waist and possibly wear a hospital gown. Each mammary gland is examined separately. The mammary gland is flattened between two panels. It might not be comfortable, but it only takes a few seconds. In order to reduce discomfort during the examination, try to avoid scheduling a mammogram right before or during menstruation, when the mammary gland is more sensitive.Also, do not use underarm deodorants on the day of the study.
Interpretation of the examination results is the responsibility of a radiologist. The result becomes known quickly enough, from several hours to a day, depending on the workload of the doctor. Some women may need additional shots. Doing more research does not mean you have cancer. Additional images help the radiologist get a clearer, clearer picture of the breast tissue.The results should be discussed with your doctor.
Discussion of mammography results
If the mammography reveals changes, then your doctor will probably recommend additional tests for you. In most cases, women with abnormal mammograms do not have breast cancer.
Recommendations for breast cancer screening
When to start a mammogram
• Most experts agree that annual screening (including mammogram and breast exam) should start at age fifty.
• Some experts recommend starting mammograms at age 40. It should be noted that the results of the studies on which these recommendations are based are contradictory and do not allow an unambiguous recommendation to start screening early.
• The decision to start screening early should be discussed with your doctor, who will help you make a decision by assessing all risk factors
How Often To Get Mammograms
Women who start screening at age 40 usually have it once a year until age 50.
After age 50, most expert groups recommend screening every two years, depending on the woman’s individual breast cancer risk.
When to stop mammography.
Most expert groups recommend that the woman continue to have routine mammograms and clinical examinations throughout her life. This recommendation is explained by the fact that the risk of developing breast cancer increases with age.
90,000 98% of women can be cured of breast cancer if the disease is detected at an early stage
As world statistics show, if breast cancer is detected at the first stage, then in 98% of cases, with appropriate treatment, you can completely get rid of the disease.At this stage, the neoplasm does not exceed two centimeters in diameter and can be easily removed.
As the stage of cancer progresses, the chance of recovery decreases. In the second stage of the disease, the size of the tumor ranges from two to five centimeters in diameter, cancer cells are present in 4-5 lymph nodes. If you learn about a malignant breast tumor in the second stage, then the chance of recovery is 93%.
“At the third and especially the fourth stage, getting rid of the neoplasm of the mammary glands is much more difficult.Therefore, it is important to be attentive to breast health and to regularly visit a doctor, ”said Guram Kvetenadze, head of the department of breast surgery and reconstruction of the Moscow Scientific Center for Science and Technology. Loginova DZM.
The Metropolitan Department of Health recalled that breast cancer is the most common cancer in women, and also urged them to undergo regular breast examinations by medical specialists. The optimal frequency is considered to be once every two years.If the doctor finds any changes, then it is necessary to make a diagnosis in accordance with the recommendations of the doctors.
From October 19 to November 3, on weekends, 71 medical organizations of the DZM will wait for patients for a free breast health check-up. Women from 18 to 39 years old are offered to undergo an ultrasound examination, and women over 40 – mammography. On Saturdays, doctors will have an appointment from 9:00 to 18:00, on Sundays – from 9:00 to 15:00. Pre-registration is required by the contact phone number of the organization.
Open diagnostic days at cancer hospitals and lectures at the School of Women’s Health will take place on 19 and 26 October.
Events within the framework of the World Day Against Breast Cancer are held in 79 medical organizations of the Moscow Department of Health from October 12 to November 3. A complete list of activities is available on the website https://mosgorzdrav.ru/rmj