Cyriax syndrome: a misdiagnosed condition of the chest wall

Abstract

Cyriax syndrome is a rare entity of the chest wall, which mainly affects young people. It can manifest as abdominal pain in the right or left hypochondriac region, which may be very intense, and often causes problems in the differential diagnosis. We report the case of a 36-year-old man who presented with intense left hypochondrial pain, worsening on exercise. After multiple specialized consultations and several unnecessary and expensive investigations, a diagnosis of Cyriax syndrome was obtained. A thorough physical examination might have been sufficient to evoke the diagnosis.

Osteo-cartilaginous pain syndromes at the chest wall: results of costal cartilage excision

“…Numerous clinical case series that were published in the past observed the emergence of CS in patients following chest trauma ( Table 4 ) ( 9 , 10 , 16 , 17 , 19 - 27 ). In numerous additional case reports, respiratory diseases, pregnancy and childbirth have been suggested as yet other causes for CS ( 28 ).…”

“…Unfortunately, these rare osteo-cartilaginous pain syndromes (OCPSs) are still little known, even among thoracic surgeons, and often the pain complained by the patients cannot be clearly assigned to one of these pain syndromes. Diagnosis is often delayed due to non-specific clinical symptoms, unhelpful imaging results, and unclear etiology ( 9 ). In clinical practice, other diagnoses like urolithiasis, a cardiac- or pleural genesis are considered first.…”

“…Therapeutic intercostal blocks with glucocorticoids, local anesthetics, or Botulinum toxin have a high chance of achieving temporary pain reduction, but not lasting pain relief ( 16 , 17 ). Surgical costal cartilage excision (CCE) has been shown to resolve symptoms ( 3 , 9 , 18 ). However, in larger studies, a failure rate exceeding 25% has been reported and additional surgical measures including rib stabilization have been suggested ( 14 , 19 , 20 ).…”