Updated 27 July 2015

Answer: What's your diagnosis? – Case 20

Mr Q started experiencing right-sided chest pain. Based on his history and examination he most likely suffers from costochondritis, or inflammation of the joint where the ribs and cartilage join one another.


Mr Q's history is suggestive of costochondritis – a fairly painful condition which may easily be confused with pain of cardiac origin (like a heart attack). There are, however, a number of differences:

1. With costochondritis the pain is mostly localised (specific to a certain area)

2. The pain is usually not sudden in onset and can come along over a couple of days

3. The patient is usually able to pinpoint exactly where the pain is situated

4. The pain does not usually radiate (spread to other areas).

Costochondritis, in most cases, does not have a clear cause, but can follow a respiratory tract infection or repetitive strain on rib cage (like injury or coughing). It is important to make sure the pain is not cardiac in origin and therefore your doctor will do a couple of tests to exclude heart problems as the cause of pain.

Shortness of breath, sweating and severe discomfort

Pain with a cardiac cause will, in most cases, be a central, dull, persistent, sudden onset pain which may also radiate to the jaw, neck and arm. It is also accompanied with shortness of breath, sweating and severe discomfort.

The most common site for costochondritis is on the left side (which may make one suspect a heart condition) over ribs 4,5 and 6. The pain is often worsened by breathing in (when the chest cage expands) and can be reproduced when pressing on the cartilage-bone junction of the ribs.

Special investigations are important in differentiating between cardiac pain and costochondritis. An ECG and cardiac markers can show possible cardiac changes. It is important to remember that, early in ischaemic heart conditions, an ecg and blood tests can be normal.

People suffering from costochondritis are usually not admitted to hospital and treatment is focused on clearing up the inflammation. Anti-inflammatory medication is therefore key in managing the condition. Depending on the cause, conservative management with medication and rest is usually sufficient. If a clear infectious cause is found (bacterial), intravenous antibiotics may be considered.

Costochondritis can be a very painful condition. All chest pain should be examined by a doctor.


NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis - Case 1: vomiting and weight loss

What's your diagnosis - Case 2: eye pain

What's your diagnosis - Case 3: strange behaviour and a bullet in the back

What's your diagnosis - Case 4: seeing odd things

What's your diagnosis - Case 5: mysterious lungs

What's your diagnosis - Case 6: runner with seizures

What's your diagnosis - Case 7: swollen knee

What's your diagnosis - Case 8: bloody semen

What's your diagnosis - Case 9: confusing neurological signs

What's your diagnosis - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis - Case 11:bruising with no apparent cause

What's your diagnosis - Case 12: severe tummy pain

What's your diagnosis - Case 13: severe sore throat

What's your diagnosis - Case 14:abdominal pain and swelling

What's your diagnosis - Case 15: the world is spinning

What's your diagnosis? – Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? – Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

Image: Chest pain from Shutterstock

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.


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