Costochondritis- Two Different Types of Costo.

Contrary to popular belief. Well...maybe not popular- since no one seems to know what in the world costo is. =) Anyway. The different kinds of costochondritis are inflammatory costo and Infectious Costo. Below you'll find the different kinds and how they are generally daignosed. You'll read about the different causes of infectious costochondritis as well. My goal is to put as much information out there so all of us crazy cats can heal!

Costochondritis - The Different Kinds of Costo. by Richard M. Kravitz

• Inflammation of unknown or known (such as fibromyalgia) origin (histologic examination can be normal if origin is unknown)
• Infection:
  • Can present months to years after surgery (the costal cartilage is avascular, making it vulnerable to infection if it has been exposed, injured, or denuded of perichondrium)
  • Complication of median sternotomy
  • Occurs by spread from adjacent osteomyelitis or may arise de novo during surgery

Costochondritis - How you got it

• Infectious:
  • Bacterial:
    • Staphylococcus aureus
      
      (especially after thoracic surgery)
    • Salmonella (in sickle cell disease)
    • Escherichia coli
    • Pseudomonas species
    • Klebsiella species
    • OR
      
  • Fungal:
    • Aspergillus flavus
    • Candida albicans
    • OR
      
• Posttraumatic injury
• Inflammation costo from known or unknown origin
  

Costochondritis - Diagnoses, signs & symptoms

Costochondritis - history

• Inflammatory costochondritis:
  • Pain usually preceded by exercise or an upper respiratory tract infection
  • Description of pain:
    • Usually sharp
    • Affects the anterior chest wall
    • Localized or radiates to the back or abdomen
    • Usually unilateral (left side greater than right side)
  • The 4th to 6th costochondral junction is the usual site of pain.
  • Motion of the arm and shoulder on the affected side elicits the pain.
  • Girls are affected more often than are boys.
• Tietze syndrome:
  • Onset is usually abrupt, but can be gradual.
  • Believed to be caused by a minor trauma, though etiology is unknown
  • Description of pain:
    • Radiates to arms or shoulder
    • May last up to several weeks
    • Swelling at the sternochondral junction may persist for several months to years
  • Usually affects the 2nd or 3rd costochondral joint
  • Pain is aggravated by sneezing, coughing, deep inspiration, or twisting motions of the chest
  • No differences in frequency between sexes
• Infectious costochondritis:
  • Slow, insidious course
  • Usually unimpressive clinical symptoms

Costochondritis - physical exam

• Usually normal
• Inspect for evidence of trauma, scars, bruising, and swelling
• Palpation and percussion of the costochondral and costosternal junctions should reproduce and localize the pain.
• In Tietze syndrome, spindle-shaped swelling is visible at the sternochondral junction.

Costochondritis - tests that have been used and not been helpful

Costochondritis - lab

• WBC count not helpful (even when infection present)
• EKG (may be helpful if cardiac etiology is being considered)

Costochondritis - The different types of imaging used to try and diagnose Costo.

• Radiologic studies (chest x-ray, CT) usually not helpful
• Gallium scan:
  • May be useful in some cases of infectious origin
  • Not highly specific
  • May show increased radionuclide uptake
  • No evidence of osteomyelitis of the sternum in most cases
• Technetium bone scan:
  • Not highly specific

"Infectious (bacterial or fungal) costochondritis should be treated initially with IV antibiotics. Afterward, antibiotics by mouth or by IV should be continued for another two to three weeks to complete the therapy." (information from webmd.com)