Costochondritis

Costochondritis is a topic covered in the 5-Minute Pediatric Consult.

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Basics

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

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