eMedicine Specialties > Emergency Medicine > Rheumatology

Costochondritis: Differential Diagnoses & Workup

Author: Lynn K Flowers, MD, MHA, FACEP, Assistant Professor, Department of Emergency Medicine, Emory School of Medicine; Clinical Faculty, Department of Emergency Medicine, Emory University Hospital
Contributor Information and Disclosures

Updated: Aug 25, 2009

Differential Diagnoses

Abdominal Trauma, Blunt
Herpes Zoster
Acromioclavicular Injury
Myocardial Infarction
Anxiety
Neoplasms, Lung
Gout and Pseudogout
Sternoclavicular Joint Injury

Other Problems to Be Considered

Pericarditis
Pleurodynia
Polychondritis
Fibromyalgia

Workup

Laboratory Studies

  • No specific studies exist for costochondritis. The clinical scenario and the most likely differential diagnoses should guide which laboratory tests are obtained.

Imaging Studies

  • Obtain a chest radiograph in the workup of the differential diagnoses.
  • Some case reports exist where bone (gallium) scans have been used in the United States to confirm the clinical diagnosis, although these are not ED studies.

More on Costochondritis

Overview: Costochondritis
Differential Diagnoses & Workup: Costochondritis
Treatment & Medication: Costochondritis
Follow-up: Costochondritis
References

References

  1. Disla E, Rhim HR, Reddy A, Karten I, Taranta A. Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med. Nov 14 1994;154(21):2466-9. [Medline].

  2. Fam AG, Smythe HA. Musculoskeletal chest wall pain. CMAJ. Sep 1 1985;133(5):379-89. [Medline].

  3. Gotway MB, Marder SR, Hanks DK, Leung JW, Dawn SK, Gean AD, et al. Thoracic complications of illicit drug use: an organ system approach. Radiographics. Oct 2002;22 Spec No:S119-35. [Medline].

  4. Sik EC, Batt ME, Heslop LM. Atypical chest pain in athletes. Curr Sports Med Rep. Mar-Apr 2009;8(2):52-8. [Medline].

  5. Bayer AS, Chow AW, Louie JS, Guze LB. Sternoarticualr pyoarthrosis due to gram-negative bacilli. Report of eight cases. Arch Intern Med. Aug 1977;137(8):1036-40. [Medline].

  6. Fam AG. Approach to musculoskeletal chest wall pain. Prim Care. Dec 1988;15(4):767-82. [Medline].

  7. Ikehira H, Kinjo M, Nagase Y, Aoki T, Ito H. Acute pan-costochondritis demonstrated by gallium scintigraphy. Br J Radiol. Feb 1999;72(854):210-11. [Medline].

  8. Physician's Desk Reference. Motrin. In: Physician's Desk Reference. 50th ed. Medical Economics Co: Montvale, NJ; 1996:2526-27.

  9. Semble EL, Wise CM. Chest pain: a rheumatologist's perspective. South Med J. Jan 1988;81(1):64-8. [Medline].

  10. Trentham DE, Le CH. Relapsing polychondritis. Ann Intern Med. Jul 15 1998;129(2):114-22. [Medline].

  11. Wadhwa SS, Phan T, Terei O. Anterior chest wall pain in postpartum costochondritis. Clin Nucl Med. Jun 1999;24(6):404-6. [Medline].

  12. Wolf E, Stern S. Costosternal syndrome: its frequency and importance in differential diagnosis of coronary heart disease. Arch Intern Med. Feb 1976;136(2):189-91. [Medline].

Further Reading

Keywords

costochondritis, costal chondritis, costochondral joints, costosternal joints, costal cartilage, chest pain, fibrositis, Tietze syndrome

Contributor Information and Disclosures

Author

Lynn K Flowers, MD, MHA, FACEP, Assistant Professor, Department of Emergency Medicine, Emory School of Medicine; Clinical Faculty, Department of Emergency Medicine, Emory University Hospital
Lynn K Flowers, MD, MHA, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

William K Chiang, MD, Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center
William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gino A Farina, MD, Program Director, Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine
Gino A Farina, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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