Chest wall syndrome, anterior

Costochondritis is an inflammation of the costochondral junction. It is sometimes known as anterior chest wall syndrome. It is characterized by chest pain aggravated by coughing, sneezing, or deep inhalation. The patient often believes he is having cardiac pain, so this can be a frightening condition. Adding to the diagnostic problem is the fact that the pain can radiate to the shoulder. 

Palpation of the costochondral junction elicits tenderness. There seldom is swelling. It must be differentiated from Tietze syndrome, which is similar in symptomatology. However, Tietze syndrome is generally more localized and swelling is usually present. Costochondritis must also be differentiated from somatic dysfunction, another cause of anterior chest wall pain. Evaluation of rib motion will usually allow a diagnosis however, motion may be restricted in the presence of costochondritis as well. 

A case of frastuzumab-associated cardiomyopathy presenting as an acute coronary syndrome was reported in a 58-year-old man with metastatic adenocarcinoma who developed chest tightness and shortness of breath immediately following his third trastuzumab infusion. An echocardiogram demonstrated new anterior and anteroseptal wall motion abnormalities and an ejection fraction of 40%. Trastuzumab was witiidrawn but lOweeks later left ventricular dys-fxmction persisted with ejection fractions of 40% apparently demonstrating irreversible cardiac damage despite withdrawal of the drug, minimal epicardial disease and standard heart failure treatmenf [213 ]. 

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