Costochondritis, also known as chest wall pain or Tietze syndrome, is inflammation of the cartilage that connects the ribs to the breastbone (sternum). This inflammation can cause localized chest pain and tenderness that may be similar to the pain of a heart attack or other heart conditions. Because of this, doctors will often order tests like an electrocardiogram (ECG) or chest x-ray to rule out heart disease in patients with chest pain. Some doctors may also consider ordering an ultrasound to look for signs of costochondritis.
An ultrasound uses high-frequency sound waves to create images of structures inside the body. It can help identify issues with organs, muscles, tendons, and more. But can an ultrasound reliably diagnose costochondritis? Here is a closer look at how ultrasounds work, what they can show, and the role they play in evaluating costochondritis.
How Ultrasounds Visualize Soft Tissues
Ultrasounds work by using a transducer or ultrasound probe to send out high-frequency sound waves that bounce off tissues in the body. The echoes that bounce back are converted into images that show up on a screen. Denser tissues like bone will reflect more of the sound waves and appear white on the image. Softer tissues absorb more of the sound waves and appear gray or black.
This ability to differentiate soft tissues makes ultrasound useful for looking at organs, muscles, and other structures that x-rays cannot visualize well. Ultrasounds are often used to examine the heart, blood vessels, uterus, ovaries, eyes, thyroid, liver, kidneys, gallbladder, pancreas, spleen, and more. They can also be used to look at muscles, tendons, and joints throughout the body.
When it comes to the chest area, ultrasound has the advantage of providing clear images of the soft tissues of the chest wall without exposure to radiation. It allows doctors to see the cartilage connections between the sternum and ribs as well as the muscles between the ribs. Fluid buildup, masses, tears, and other abnormalities may also be detected.
What Would an Ultrasound Show With Costochondritis?
With costochondritis, the primary symptom is inflammation of the cartilage and joints between the sternum and ribs. This inflammation is what causes the localized chest tenderness and pain.
An ultrasound examination of the chest wall allows the radiologist to look for signs of inflammation in these tissues. There are a few key things they would look for:
- Thickening or enlargement of the costal cartilage – Inflammation can cause the cartilage to become swollen or thicker than normal.
- Fluid around the cartilage and joints – Inflammation can also lead to an accumulation of fluid in the chest wall.
- Chest wall tenderness – Applying pressure with the ultrasound transducer can reveal areas of focal tenderness.
In addition, the radiologist may look for signs indicating another cause of the pain, such as:
- Calcium deposits or bone spurs on the cartilage
- Rib fractures
- Chest muscle strains or tears
- Chest tumors or cysts
Being able to rule out these other potential sources of pain can help confirm a diagnosis of costochondritis.
What Are the Limitations of Ultrasound?
While ultrasound can provide useful images of the chest wall’s soft tissues, there are some limitations to consider:
- Operator dependence – Results rely heavily on the skill and experience of the person performing and interpreting the ultrasound.
- Difficulty visualizing deepest cartilage – The cartilage attaching to the lower ribs may be difficult to see.
- Not as detailed as MRI – Ultrasound provides good superficial images but MRI can better evaluate deeper structures.
- Cannot assess heart – Ultrasound of the chest wall does not rule out heart conditions like coronary artery disease.
Ultrasound technicians may also have difficulty distinguishing between inflammation and normal age-related changes in the cartilage that do not cause pain. There is also a lack of research on specific ultrasound findings that confirm a diagnosis of costochondritis.
Role of Ultrasound in Diagnosing Costochondritis
Due to its limitations, ultrasound is not considered a first-line test for evaluating costochondritis. Doctors more commonly diagnose costochondritis based on:
- Medical history – such as recent trauma to the chest
- Location and nature of the pain – reproduced by pressing on the cartilage
- Physical exam – pinpointing tenderness over the cartilage
- Lack of findings indicating other conditions
However, ultrasound may play a supporting role when the diagnosis is uncertain. It can help:
- Rule out rib fractures or chest muscle strains
- Look for fluid buildup or masses if a tumor is suspected
- Assess for thickening or swelling of the cartilage in chronic cases
- Guide injections into the chest wall if needed for pain relief
Ultrasound can also provide reassurance to patients that there is no serious underlying problem. Seeing normal images of the chest wall cartilage and joints may ease fears about heart disease or other dangerous conditions.
Some doctors argue ultrasound should play a larger role in evaluating costochondritis given its ability to assess the chest wall dynamically during active inflammation. But more research is needed on consistent ultrasound findings linked to a clear costochondritis diagnosis.
Other Imaging Options
In some cases, other imaging tests may be used in addition to or instead of ultrasound:
- X-ray – Can rule out rib fractures but provides limited visualization of cartilage.
- MRI – Provides detailed evaluation of cartilage, bones, muscles, and tendons without radiation exposure.
- CT scan – Provides clear images of bones and cartilage but exposes patient to radiation.
- Nuclear medicine bone scan – Used if arthritis or inflammation of cartilage is suspected.
The choice of imaging often depends on availability, cost, and whether radiation exposure is a concern. Ultrasound and MRI avoid exposing patients to radiation but availability and expense may be limiting factors.
- Ultrasound can dynamically visualize the chest wall cartilage and surrounding soft tissues.
- Signs of costochondritis on ultrasound may include thickened cartilage, fluid accumulation, and focal tenderness.
- Ultrasound has limitations and is not considered a first-line test for costochondritis.
- It may play a supporting role when the diagnosis is unclear.
- MRI and CT provide more detailed imaging but have drawbacks like radiation exposure and availability.
The Bottom Line
While ultrasound can reveal abnormalities in the chest wall’s cartilage and soft tissues, it has limitations in its ability to definitively diagnose costochondritis. Ultrasound findings must also be correlated with a patient’s medical history and physical exam. In many cases, a diagnosis can be made based on a typical presentation of chest wall tenderness without imaging tests.
But ultrasound may provide added reassurance and rule out other causes in challenging cases. It can also dynamically assess the chest wall during active inflammation. With further research on signature ultrasound findings in costochondritis, its diagnostic role may expand in the future. For now, it serves largely as an adjunct to help guide or confirm a diagnosis when clinical uncertainty exists.