Although Tietze1 reported the syndrome of painful enlargement of the costal cartilages in 1921, this condition received little attention in American literature until recently. Tietze's original description of 5 cases has been followed by reports of more than 160 other examples of the same disease. The first American paper on Tietze's syndrome was written in 1953, and subsequently there have been at least five additional major papers produced in this country. Tietze disease has been variously referred to as the costochondral syndrome, painful swelling of the chondrocostal region, costal chondritis, stress fracture of upper ribs, and prominent costal cartilages. Since the pathogenesis of the disease is unknown, the eponym designation is useful at the present. Tietze originally suggested that tuberculosis or wartime malnutrition might have been etiologic factors. Subsequent authors have proposed that buckling of the cartilage due to an inflammatory reaction in the ligaments immediately behind it,2 trauma to