Investigations
1st investigations to order
non-steroidal anti-inflammatory drug trial
Test
Can be given when there is a strong clinical suspicion.
Result
pain relief
Investigations to consider
local anaesthetic and corticosteroid trial
Test
Can be used when there is a strong clinical suspicion. Usually performed by a specialist (e.g., rheumatologist)
A beneficial response to treatment with a local anaesthetic injection helps to support the diagnosis.
A failure to respond to treatment should prompt further investigation (e.g., chest CT) to consider differential diagnoses.
Result
pain relief
chest x-ray
Test
Not routinely required if the diagnosis of costochondritis is clinically clear. Most helpful in ruling out other aetiologies such as infection or a mass.
Result
normal or chondral enlargement
CT chest
Test
Not routinely required unless infection or alternative diagnosis suspected.[10]
Result
normal or chondral enlargement, low attenuation cartilage, associated soft-tissue swelling or calcification
MRI chest
Test
Not routinely required, but may be used as an alternative to CT.[15]
Result
enlargement, thickening, and increased signals on T2/STIR/FAT-SAT sequences on affected cartilage; bone marrow oedema; increased gadolinium uptake
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