E1488. What a Pain in the Chest: Imaging in Chest Wall Syndrome
  1. Chanel Wood; Mayo Clinic Florida
  2. Justin Stowell; Mayo Clinic Florida
  3. Elizabeth Johnson; Mayo Clinic Florida
  4. Patricia Mergo; Mayo Clinic Florida
  5. Carlos Rojas; Mayo Clinic Florida
  6. Sushilkumar Sonavane; Mayo Clinic Florida
  7. Hilary Garner; Mayo Clinic Florida
Chest wall syndrome refers to a variety of conditions that may manifest with pain of thoracic musculoskeletal origin. Most non-traumatic chest wall pain can be explained by self-limited inflammatory conditions (e.g., costochondritis). These conditions can usually be diagnosed clinically with no need for imaging. For example, reproducible pain at palpation has a high negative predictive value, allowing for exclusion of acute coronary syndrome in patients who present with acute chest pain. Patients with developmental chest wall variants may benefit from various surgical procedures that are intended for alleviation of chronic pain and respiratory compromise, as well as for improvement of chest wall aesthetics. The aim of this presentation is to broaden the radiologist’s differential diagnosis for chest wall syndrome and describe how imaging can be important for both diagnosis and occasionally pre-operative planning.

Educational Goals / Teaching Points
After reading this presentation, the learner will recognize relevant chest wall anatomy; understand the utility of imaging in the evaluation of non-traumatic, non-neoplastic chest wall pain; understand the most common clinical and imaging manifestations of potentially pain-generating chest wall conditions, including inflammatory, metabolic, inherited, and infectious disorders and developmental conditions; inflammatory disorders, metabolic conditions, inherited disorders, infection and developmental variants; and understand the role of surgical management for certain conditions and utility of pre-operative image planning.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Two view chest radiographs are generally indicated as an initial evaluation of chest wall pain. However, non-traumatic, non-neoplastic etiologies often necessitate more advanced imaging. For example, computed tomography can identify radiographically occult sternal insufficiency fractures and is indicated for pre-operative planning for pectus deformity repair. Magnetic resonance imaging can be helpful in evaluation of some inflammatory conditions, including ankylosing spondylitis or, where there is diagnostic uncertainty, chostochondritis. SAPHO syndrome has a characteristic appearance on nuclear medicine bone scan which can suggest the diagnosis.

Non-traumatic, non-neoplastic chest wall pain can be a diagnostic conundrum leading to an extensive clinical and imaging evaluation. Increasing the radiologist’s awareness of the most common etiologies of chest wall pain can potentially expedite diagnosis and spare the patient additional anxiety and unnecessary testing.