Costochondritis

Description

Costochondritis is chest pain that emanates from a costal cartilage and is reproducible on compression of that cartilage.

Epidemiology

• Frequency of sternal wound infections following median sternotomy is 0.1–1.6%.
• Costochondritis accounts for 10–31% of all pediatric chest pain.
• Peak age for chest pain in children is 12 to 14 years.

Pathophysiology

• Inflammation of unknown etiology (Histologic examination is usually normal.)
• Infection
  • Can present months to years after surgery (The costal cartilage is avascular, making it vulnerable to infection if it has been exposed, injured, or denuded of perichondrium.)
  • Complication of median sternotomy
  • Occurs by spread from adjacent osteomyelitis or may arise de novo during surgery

Etiology

• Infectious
  • Bacterial
    • Staphylococcus aureus (especially after thoracic surgery)
    • Salmonella (in sickle cell disease)
    • Escherichia coli
    • Pseudomonas sp.
    • Klebsiella sp.
  • Fungal
    • Aspergillus flavus
    • Candida albicans
• Posttraumatic injury