Costal chondritis is a common disease in outpatient or postoperative cardiothoracic surgery and is divided into septic costal chondritis and nonspecific costal chondritis (Tietze’s syndrome). The wide variety of treatment methods with poor results, prolonged course and easy recurrence have troubled patients and clinicians. The following is a review of the diagnostic, surgical, and other treatment advances for this disease. Tietze’s syndrome was first reported by Tietze in 1921 and defined as an unexplained, nonsuppurative inflammatory lesion of the rib cartilage at the junction of the rib and sternum that presents as a self-limiting disease with limited pain accompanied by swelling, and is discussed here with emphasis on this disease. Epidemiology and etiology of costochondritis is common in patients aged 20-30 and 40-50 years, with similar incidence on the left and right side, 70-80% unilateral and solitary lesions, with no significant gender predilection, while the domestic literature reports a prevalence in women. The etiology is unknown, and the following hypotheses have been suggested: 1. Most scholars believe that it may be related to microtrauma of the costal cartilage membrane and strain caused by local stress abnormalities in the ligaments of the sternocostal joints. 2. It may be related to upper respiratory tract viral infections. 3. 3. It may be related to immune or endocrine abnormalities causing nutritional disorders of the rib cartilage. Clinical manifestations and diagnosis of costochondritis can occur in all rib cartilages, mostly in the parasternal 2-4 ribs, and also in the rib arch. In mild cases, only mild chest tightness is felt, and the pain in front of the chest is mostly dull or hidden, occasionally accompanied by stabbing pain, and the pain point is fixed and does not move, and the pain increases when the thorax is overactive due to coughing, deep breathing, and expansion of the chest wall. In severe cases, the shoulder and arm are afraid to move, or even involve half of the body. The course of the disease mostly heals on its own in 3-4 weeks, but some patients have recurrent episodes, which can be prolonged for months or even years. The affected costal cartilage is enlarged and elevated, hard, smooth and poorly defined, with significant local pressure pain, but no epidermal redness or heat, and the pain increases when the thorax is squeezed. In multiple cases, the involved costal cartilage may show a bead-like deformity. MRI can show active inflammatory changes in bone, cartilage, synovium and bone marrow with high specificity and sensitivity. Ultrasound is able to show swelling and structural alterations of the rib cartilage that cannot be shown by X-ray, avoiding false positives or false negatives of CT due to volumetric effects and body position, and making it easy to observe swelling changes by bilateral comparison. The diagnosis of costochondritis is confirmed on the basis of clinical manifestations and signs after exclusion of other diseases by detailed history, careful physical examination and ancillary tests. Differential diagnosis of costochondritis There are many causes of anterior chest wall pain, and costochondritis accounts for about 30%. Local pain without swelling should be distinguished from intercostal neuralgia, herpes zoster, reflux esophagitis, coronary angina, and diseases of the hepatobiliary system; local swelling and pain should be distinguished from rib cartilage tumors, chest wall tuberculosis, and bone scab formation after fracture. Signs and symptoms of the disease can be seen in any joint disease involving the anterior chest wall such as psoriatic arthritis, gout, tumors, and dense osteitis, with ankylosing spondylitis and rheumatoid arthritis involving the sternoclavicular joint being more common. The possibility of lymphoma, multiple myeloma, plasma cell tumor, and metastatic carcinoma to the bone exists and requires biopsy to exclude if necessary to avoid misdiagnosis. Prevention of costochondritis When performing open-heart surgery, the scope of sterilization should be adequate, strict aseptic operation, shorten the operation time, reduce unnecessary electrocautery and injury, pay attention to the protection of the costochondral membrane, and apply antibiotics in sufficient quantity at an early stage. If the rib cartilage needs to be cut off during surgery, the periosteum of the rib cartilage at the site to be removed should be deliberately peeled off and preserved through preventive surgical techniques, and the stump of the rib cartilage should be closed with periosteal sutures to improve the blood supply to the cartilage stump and avoid exposing the cartilage.