Cartilage itself is an avascular tissue, and its blood supply mainly comes from the perichondrium. Therefore, once the perichondrium is infected, the cartilage, lacking a blood supply, becomes necrotic, leading to a wound that does not heal for a long time. Additionally, due to the anatomical characteristics of costal cartilage, inflammation from cartilage infection can often spread to adjacent fused cartilage. The first to fourth costal cartilages exist independently, so infection in one does not spread to neighboring costal cartilages, and removal of a single costal cartilage can lead to a cure. However, the fifth or sixth to tenth costal cartilages are interconnected, so infection in any one of them can affect a large area of costal cartilage on the same side, and can even spread to the contralateral costal cartilage through the xiphoid cartilage.

bubble_chart Etiology

Primary costal chondritis is relatively rare, and its causative bacteria are often subcutaneous node bacilli, cold-damage disease bacilli, or para-cold-damage disease bacilli, which infect through the bloodstream. Currently, costal chondritis caused by infection after thoracic surgery is more common, with its primary causative agents being pyogenic bacteria and fungi.

bubble_chart Clinical Manifestations

Suppurative costal chondritis is primarily characterized by redness, swelling, fever, and pain in the local costal cartilage area. Patients may experience fever, elevated white blood cell count, soft tissue necrosis leading to abscess formation, and the development of persistent sinuses upon rupture. Sometimes, the costal cartilage can be observed at the site of rupture. Chest X-rays can rule out localized empyema, and X-ray iodized oil sinusography can delineate the extent of the lesion.

Surgery is the only treatment method that yields good results. All affected costal cartilages should be removed during the surgery. For those involving the costal cartilage arch of the lower chest wall, considering that a one-time removal of all infected costal cartilages may be too extensive, which could lead to chest wall softening and paradoxical breathing postoperatively, staged resection can be considered for patients with poor respiratory function and elderly patients. The chest wall after the removal of costal cartilages is eventually replaced and stabilized by fibrous scar tissue. In cases of costal chondritis from the 5th to the 10th rib, infection in any one costal cartilage can affect the entire connected costal cartilage and arch. If early costal chondritis has not affected the entire cartilage area, a staged and compartmentalized surgical approach can be adopted to prevent the expansion and spread of chondritis. Typically, after removing normal cartilage in the normal cartilage area, the cartilage membrane is preserved to cover the cartilage section and separate it from the infected area. After the incision heals, if necessary, all infected costal cartilages in the infected area can be removed. Generally, for the infected area after surgical removal, the wound should be left completely open or partially sutured to ensure smooth drainage, with daily dressing changes until the wound heals naturally with the growth of granulation tissue.