Background
Chest pain is a common reason parents seek medical attention for their children. Annually, physicians evaluate >600,000 cases of chest pain in patients aged 10-21 years, a number that may reflect overwhelming concern about chest pain as a manifestation of cardiac disease as noted in older patients. [1, 2]
Costochondritis is a common cause of chest pain in children and adolescents. The condition is characterized as an inflammatory process of one or more of the costochondral cartilages that causes localized tenderness and pain of the anterior chest wall. [3] Most cases of costochondritis are idiopathic. The remaining cases may result from costochondral irritation due to direct trauma to the area, aggressive exercise resulting in a strain of the costochondral cartilage, or a prior upper respiratory tract infection with cough which can cause repeated stretching and strain at the costochondral junction resulting in local irritation and pain.
Costochondritis is a relatively benign and usually self-limited condition though symptom resolution can persist for up to three months. [4] Patients are often evaluated initially in the emergency department (ED) or in their primary care physician's office.
The term Tietze syndrome implies swelling; costochondritis refers to pain alone.
Pathophysiology
The exact pathophysiology of cartilage and capsular involvement is unknown because costochondritis does not warrant surgical intervention or tissue biopsy. Theoretically, the cartilage involved in costochondritis is either inflamed or fractured. Either condition presumably leads to inflammation with subsequent stimulation of pain receptors.
Epidemiology
Frequency
United States
Several studies of chest pain in pediatric patients report costochondritis prevalences of 14-32% [4, 1, 5, 6] ; a single study reported rates as high as 79% [7] however this higher prevalence may be due to a less stringent diagnostic criteria for costochondritis. The overall incidence is approximately 4% in children and adolescents.
Mortality/Morbidity
No reports have associated mortality with costochondritis, and no mortality is expected.
Race
A study indicates Hispanics may have an increased prevalence of costochondritis, but most studies do not mention race as a factor. [8]
Sex
Studies of chest pain in children demonstrate that males and females are affected equally. There are no recent studies evaluating the effect of gender in costochondritis.
Age
No data support an association between age and costochondritis; the condition is well described in children of all ages, including infants. [9]
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Sternocostal and interchondral articulations. Anterior view.
