Pediatric Costochondritis Workup

Updated: Aug 20, 2018
  • Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Lawrence K Jung, MD  more...
  • Print
Workup

Laboratory Studies

See the list below:

  • Costochondritis has no confirmatory or diagnostic laboratory tests.

Next:

Imaging Studies

See the list below:

  • Imaging studies are unnecessary to confirm a diagnosis of costochondritis.

  • Chest radiography may exclude other possible causes of chest pain but offer no diagnostic value to the clinical diagnosis of costochondritis. Occasional localized peripheral calcifications may be noted on chest radiography. In the absence of confounding physical findings, the diagnostic yield of a chest radiograph is minimal.

  • In the unusual circumstance that imaging is required, CT scanning is probably the best choice because it can demonstrate swelling or low attenuation signal of the costal cartilage. [18] Ultrasonography may also demonstrate swelling but is highly user dependent and thus generally less useful. Bone scanning may demonstrate uptake at the area of concern; however, increased uptake at costochondral junctions that do not produce symptoms may also be present, making this modality less useful. [19]

  • MRI can be utilized as an alternate imaging study in rare circumstances. While the costochondral cartilage can be well defined with this modality, there are no known studies utilizing MRI in this role. Furthermore, younger children may need to be sedated in order to obtain images thus increasing overall risk of this study in the younger age group.

Previous
Next:

Procedures

See the list below:

  • Costochondral joint injection is indicated for patients with severe pain for whom oral analgesics are either ineffective or contraindicated. Costochondral joint injection may have a role in treating refractory cases of costochondritis. Using a 22-gauge needle, inject 2% lidocaine or a combination of corticosteroid and lidocaine. A total volume ranging from 1-3 mL may be injected depending on patient size.

  • Contraindications include an uncooperative patient, known hypersensitivity to the injectant, unclear diagnosis, or unstable cardiopulmonary disease. Use caution in patients with a severe coagulopathy. Complications include bleeding, infection, and pneumothorax.

  • Manipulation using a high velocity, low amplitude technique has been described to produce relief in costochondritis, but no larger studies have been done to confirm this. [20]

Previous