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Tietze's syndrome is a relatively rare disorder, characterized by non-suppurative inflammation affecting the costo-sternal and sterno-clavicular joints. We describe the case of a patient affected by Tietze's syndrome clinically presenting with sudden onset of chest pain, initially diagnosed as anterior mediastinal malignancy on multidetector computer tomography. In order to characterize the nature of the lesion, we performed an open biopsy that disclosed no malignant cells. The patient was treated with non-steroidal anti-inflammatory drugs and local intramuscular injections; a progressive decrease of the mass was observed. MRI of the anterior thoracic wall disclosed spongious edema of the left sterno-clavicular joint, cortex preserved and soft-tissue edematous thickening. These findings were consistent with Tietze's syndrome.

Torsion of accessory spleen is an extremely rare entity with variable clinical presentation. We report a case of torsion of an accessory spleen in a apiretic 37-year-old woman who presented to our emergency department with a continuous left abdominal pain, posteriorly radiated, without any gastrointestinal or urinary sign. Laboratory findings were normal. CT disclosed a hypodense mesenteric mass with peripheral fat tissue inflammation. After a few hours the patient presented with acute abdomen and was taken to the operating room with diagnosis of torsion of an accessory spleen. Preoperative diagnosis is difficult because of lack and non-specificity of presenting symptoms, until splenic torsion occurs: knowledge of this pathology and its radiological signs are fundamental for a correct diagnosis.