Exams and Tests

Costochondritis does not lend itself to diagnosis by tests. Personal history and physical exam are the mainstays of diagnosis. Tests however are sometimes used to rule out other conditions that can have similar symptoms but are more dangerous, such as heart disease.

• The doctor will seek to reproduce tenderness over the affected rib joints, usually over the fourth to sixth ribs in costochondritis, and over the second to third ribs in Tietze syndrome. In costochondritis with unknown causes, there is no significant swelling of costochondral joints.
  
  
• There is swelling as well as tenderness of the rib-cartilage junctions in Tietze syndrome. Although some doctors use the terms costochondritis and Tietze syndrome interchangeably, Tietze syndrome has a sudden onset without any preceding respiratory illness or any history of minor trauma. In Tietze syndrome, there is frequently radiation of pain to arms and shoulders as well as pain and tenderness associated with swelling at the spot that hurts.
  
  
• Blood work and a chest x-ray are usually not helpful in diagnosing costochondritis. However, after sternum surgery, or for people at risk for heart disease, doctors will be more likely to do tests if you have chest pain and possible costochondritis to be certain you do not have any infection or other serious medical problems.
  
  
  • They will look for signs of infection such as redness, swelling, pus, and drainage at the site of surgery.
    
    
  • A more sophisticated imaging study of the chest, a gallium scan, is used to check for infection. It will show increased uptake of the radioactive material gallium in an area of infection.
    
    
  • In cases of possible infection, the white blood cell count may be elevated.
    
    
  • Chest x-ray should be obtained if pneumonia is a suspected cause of chest pain.
    
    
  • ECG and other tests will be done if a heart problem is being considered.
  
  
• Costochondritis is a less common cause of chest pain in adults but one that occurs fairly frequently in people who have had cardiac surgery. The diagnosis can only be reached after excluding more serious causes of chest pain that are related to the heart and lungs. The appropriate studies, such as ECG, chest x-rays, blood test for heart damage (cardiac enzymes and troponin levels), and other studies will be done as indicated. Any chest pain in adults is taken seriously and not ignored. If you are concerned, consult with your doctor.