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El síndrome de Tietze
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El síndrome de Tietze

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El síndrome de Tietze es una enfermedad osteomuscular rara, caracterizada por la inflamación benigna, no supurativa pero dolorosa de uno o varios cartílagos costales, que evoluciona espontáneamente a la curación en semanas o meses. Se caracteriza por dolor torácico intenso que puede parecerse al dolor de origen coronario y tumefacción dolorosa con o sin enrojecimiento del cartílago de una o más de las primeras costillas, especialmente en la segunda, al nivel de la articulación condrocostal o de la esternocostal. En los casos en que no existe tumefacción, se prefiere usar el término de costocondritis.

Su ocurrencia es más común en los adultos jóvenes y si bien puede aparecer a cualquier edad en la infancia es muy poco frecuente, sobre todo en niños menores de 10 años.

El inicio del dolor costal o condrocostal que es unilateral agudo y localizado puede ser gradual o repentino, preferentemente suele restringirse al área de la segunda o tercera costilla pero puede también irradiarse afectando los brazos y los hombros, aunque en los niños el dolor tiende a localizarse en los cartílagos costales bajos.

El dolor siempre es de carácter mecánico, por lo que se manifiesta o aumenta con el movimiento; maniobras como toser, estornudar o incluso la tensión emocional, incrementan el dolor.

La causa exacta del síndrome de Tietze se desconoce, pero se asocia a menudo a una infección de las vías respiratorias, traumatismos torácicos costales, o simplemente a aumentos de presión mantenidos en el tiempo o repetidos en dicha zona; también se ha descrito formando parte de enfermedades sistémicas inflamatorias, preferentemente con participación articular como poliartritis reumática, artritis psoriásica y lupus eritematoso sistémico.

Para realizar el diagnóstico la historia clínica y la exploración suelen ser suficientes, aunque ecografía, escáner y en casos excepcionales gammagrafía pueden resultar útiles para el diagnóstico de la enfermedad y especialmente para diferenciarla de otros procesos, entre otros la displasia mamaria, la mastalgia (dolor a nivel de la mama de origen mamario) que suele ser bilateral y de carácter cíclico y dolor anginoso.

Así como el síndrome de Tietze debe ser considerado en el diagnóstico diferencial del dolor torácico precordial para evitar pruebas diagnósticas y agresivas, también resulta obligado descartar un dolor anginoso o un proceso isquémico (isquemia es el déficit de riego sanguíneo) coronario en caso de que el dolor precordial no desaparezca en semanas.

Tiende a resolverse de forma espontánea en el plazo de unos dos meses pero a veces este plazo se prolonga y de forma excepcional se mantiene de forma crónica. No suele requerir tratamiento si bien se aconseja evitar cualquier movimiento que empeore los síntomas.

En ocasiones algunos pacientes mejoran con la fisioterapia respiratoria, aunque esta sólo está indicada cuando el síndrome se cronifica o asocia un proceso infeccioso respiratorio.

Los casos severos se tratan farmacológicamente, resultando de utilidad los analgésicos y en los casos más refractarios los antiinflamatorios no esteroideos, asociados o no con codeína según la intensidad del dolor y si no existen otras contraindicaciones. Excepcionalmente se han utilizado corticoides en ciclos cortos de tratamiento y también tratamiento del dolor con microondas más estimulación nerviosa transcutánea, técnica habitualmente llamada TENS, cediendo el dolor en unas dos semanas, aunque la tumefacción puede llegar a tardar meses en desaparecer.

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