Costochondritis · What Is It, Causes, Treatment, and More

Differential diagnoses involve considering various possible conditions that could be causing symptoms and then ruling out each one through use of history, clinical evaluation, diagnostic tests, and critical thinking. This process helps to narrow down the list of potential diagnoses to determine the most likely cause of the symptoms. 

Differential diagnoses can be broken down into four categories: most likely, less likely, least likely, and can’t miss. Most likely diagnoses are conditions most probable based on symptoms and clinical presentation. Less likely diagnoses are not as probable but should still be considered. On the other hand, least likely diagnoses can be considered if other, more probable conditions are excluded. Finally, can’t miss diagnoses are less common but critical to promptly identify and treat as they can lead to severe consequences.  

Costochondritis can be diagnosed clinically based on the findings from the medical history and physical exam. The most characteristic sign of costochondritis is pain and tenderness upon palpation of the affected area. Oftentimes, costochondritis is confused with Tietze syndrome, a similar but less common disorder that causes swelling of a single costal cartilage, usually of the second or third rib. Unlike Tietze syndrome, costochondritis causes diffuse pain and is generally not associated with any swelling or induration of the costochondral joints.  

In individuals with suspected costochondritis, additional tests are not necessary for the diagnosis unless diagnosis is uncertain or if fever or signs of inflammation are present. In individuals with a history or risk of heart disease, additional tests may be conducted to rule out other causes of chest pain, such as a heart attack. Other medical conditions that may need to be ruled out include pneumonia, pneumothorax, pulmonary embolism, or rib fractures, among others. Depending on the clinical suspicion, additional testing may involve an electrocardiogram (ECG), chest X-ray, or laboratory investigations.