Chest pain

Chapter 9 CHEST PAIN


Theodore X. O’Connell



General Discussion


Chest pain in children provokes considerable anxiety for patients and parents. Fortunately, several prospective studies have demonstrated that chest pain in the pediatric age group overwhelmingly is benign. Several organ systems have the potential to cause pain localizing to the thorax. The most common is the musculoskeletal system, where pain can originate from muscle bodies, tendons, ligaments, cartilage, or bone. Other organ systems that can cause chest pain include the respiratory, cardiovascular, gastrointestinal (GI) and nervous systems. Although the differential diagnosis of chest pain is exhaustive, chest pain in children is least likely to be cardiac in origin.


Chest pain is found equally in male and female patients, with an average age of presentation of 13 years. Children younger than 12 years are more likely to have a cardiorespiratory cause of their chest pain compared with children older than 12 years, who are more likely to have a psychogenic cause. Patients diagnosed with psychogenic chest pain or costochondritis are more likely to be female.


All complaints of chest pain should be taken seriously, but chest pain in the pediatric population is rarely associated with life-threatening disease. Chest pain persisting longer than several months is unlikely to be related to serious organic etiology. Pain that is constant or frequently occurring without completely subsiding typically is more worrisome than brief, infrequently occurring episodes of pain.


It may be helpful to understand how the patient and the parents perceive the chest pain. Simply asking the child or adolescent what he or she thinks is causing the pain may help to discover the cause.


Idiopathic is the most frequently encountered diagnosis for chest pain in pediatrics, and the pain is commonly chronic. When the history is unremarkable for serious pathology and the physical examination is normal, further testing generally is not necessary. Several studies have shown that without a specific indication, routine tests were of no benefit in determining the cause of the chest pain.



Causes of Chest Pain



Cardiac



• Angina/coronary artery disease


• Aortic or subaortic stenosis


• Arrhythmias


• Cardiomyopathy


• Coarctation of the aorta


• Cocaine ingestion


• Dissecting aortic aneurysm (in Marfan syndrome)


• Eisenmenger syndrome


• Endocarditis


• Hypertrophic cardiomyopathy


• Kawasaki disease


• Mitral valve prolapse


• Myocarditis


• Pericardial neoplasm


• Pericarditis


• Postpericardiotomy syndrome


• Rheumatic fever


• Structural abnormalities


• Supraventricular tachycardia


• Sympathomimetic ingestion


• Takayasu arteritis


• Vasospasm


• Ventricular tachycardia



Gastrointestinal



• Achalasia


• Cholecystitis


• Esophageal foreign body


• Esophageal rupture (Boerhaave syndrome)


• Esophageal spasm


• Esophagitis


• Gastritis


• Gastroesophageal reflux


• Hiatal hernia


• Mallory-Weiss tear


• Pancreatitis


• Peptic ulcer disease


• Perihepatitis (Fitz-Hugh-Curtis syndrome)


• Subdiaphragmatic abscess


• Zollinger-Ellison syndrome


Idiopathic



Musculoskeletal



• Ankylosing spondylitis


• Costochondritis


• Discitis


• Exercise


• Fibrositis


• Herniated disc


• Herpes zoster


• Metastatic disease


• Myositis


• Osteomyelitis


• Overuse injury (strain, bursitis)


• Pleurodynia


• Precordial catch syndrome


• Sickle cell vaso-occlusive crisis


• Slipping rib syndrome


• Spondylolisthesis


• Spondylolysis


• Thoracic outlet syndrome


• Transverse myelitis


• Trauma (including abuse)


• Tumor



Other



• Breast-related causes (adenocarcinoma, fibrocystic disease, gynecomastia, mastitis, thelarche)


• Castleman disease (lymph node neoplasm)


• Cigarette smoking


• Connective tissue disorders


• Cystic fibrosis


• Diabetes mellitus

Related posts:

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  2. Neck masses
  3. Lymphadenopathy
  4. Seizures

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Jun 18, 2016 | Posted by in PEDIATRICS | Comments Off on Chest pain

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