Chest pain in children!- common pediatric outpatient department scenario
12 years old girl comes to your outpatient clinic with history of sudden onset chest pain. Pain is sharp and localized to left chest . There is also past history of similar pain occurring at rest and resolving spontaneously with in 2-3 minutes . What is likely underlying condition?
In this case cardiac cause is uncommon. More common and identifiable causes include musculoskeletal pain (e.g., precordial catch syndrome, intercostal muscles injury, costochondritis), pulmonary disease (e.g., asthma, pneumonia, initial stage of pleural effusion), and gastrointestinal disease (e.g., esophagitis, gastric reflux etc.).
In above mentioned case child is most likely having precordial catch syndrome (Texidor Twinge). It manifests as a sudden-onset chest pain in children, very localized (patient points to area with one or two fingers), which occurs most commonly over the left sternal border or over left precordial area. Pain occurs without provocation and during rest. Pain is exacerbated by deep breaths and usually lasts for 30 seconds to 3 minutes. There is no association of palpitation , pallor , dyspnea or syncope . There is no local tenderness. Physical examination is also normal. This particular symptom often prompts extensive, and unproductive diagnostic workups. The cause is unknown. Pain may originate form parietal pleura. Management is reassurance.