Abstract
<h3>To the Editor.—</h3> The article "Chest Wall Syndrome: A Common Cause of Unexplained Cardiac Pain" by Epstein et al (241:2793, 1979) describes a symptom-sign complex in which neuromusculoskeletal derangements mimic cardiac disease. That the patient group was at a specialized tertiary care center may have contributed to the highly sophisticated, extensive, costly and (in the cases of the 12 patients described) perhaps unnecessary diagnostic evaluations the authors detailed. However, I was greatly interested in the article because of its neglect of an entity probably more commonly experienced in real-world community practice: peristernal perichondritis (Tietze's syndrome<sup>1</sup>). In 1974, I described the first reported cases of Tietze's syndrome affecting the xiphisternal joint<sup>2</sup>and, in 1977, analyzed 24 cases of xiphisternal perichondritis.<sup>3</sup>The disease has protean manifestations and is a mimic of severe cardiac, pulmonary, intra-abdominal, and other diseases. Among our patients, who ranged in age from 18 to 72
Published Version
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