Tietze's Disease Predates 'Chest Wall Syndrome'

To the Editor.—  The article "Chest Wall Syndrome: A Common Cause of Unexplained Cardiac Pain" by Epstein et al (241:2793, 1979) describes a symptom-sign complex in which neuromusculoskeletal derangements mimic cardiac disease. That the patient group was at a specialized tertiary care center may have contributed to the highly sophisticated, extensive, costly and (in the cases of the 12 patients described) perhaps unnecessary diagnostic evaluations the authors detailed. However, I was greatly interested in the article because of its neglect of an entity probably more commonly experienced in real-world community practice: peristernal perichondritis (Tietze's syndrome¹).In 1974, I described the first reported cases of Tietze's syndrome affecting the xiphisternal joint² and, in 1977, analyzed 24 cases of xiphisternal perichondritis.³ The disease has protean manifestations and is a mimic of severe cardiac, pulmonary, intra-abdominal, and other diseases.Among our patients, who ranged in age from 18 to 72