Classification of Anterior Chest Wall Syndromes

To the Editor.—  We wish to congratulate Espstein and coauthors (241:2793, 1979) for their excellent contribution on chest wall syndrome as a common cause of unexplained cardiac pain. It is clear from the description of their 12 patients that all had the anterior chest wall syndrome, more popularly known as costochondritis. The terms "Tietze's syndrome" and "costochondritis" are often used interchangeably. While both disorders are characterized by inflammation of one or more costal cartilages, Tietze's syndrome is associated with local swelling while costochondritis is not. Consequently, Tietze's syndrome is easier to recognize but unfortunately is far less common than costochondritis. In this regard, the two letters to the editor (242:2556, 1979; 242:2394, 1979) suggesting that the patients of Epstein et al had Tietze's syndrome are inappropriate.The cause of Tietze's syndrome is unknown, although minor or obscure trauma (coughing, for example) may be operative. The syndrome occurs in all age