CHEST PAIN IN PEDIATRICS
Section snippets
ANATOMY OF MAJOR THORACIC STRUCTURES CAUSING CHEST PAIN
Figure 1 demonstrates the common sites of origin of chest pain in a schematic diagram of the major structures in the chest and abdomen in the anteroposterior and lateral planes.
HISTORY
A thorough and complete history is essential for the accurate diagnosis of chest pain. One must methodically gather historical data and avoid a quick run to judgment or an exhaustive laboratory investigation when evaluating chest pain. A comprehensive time series of events leading up to, through, and after the episode of chest pain should be documented. The pain should be described with respect to time of onset, duration, frequency, nature, intensity, location, points of radiation,
PHYSICAL EXAMINATION
A thorough and complete physical examination is fundamental to an accurate diagnosis of chest pain. During the physical examination, particular attention must be given to the child's vital signs (including blood pressure), general appearance and state (e.g., cyanotic, comfortable, distressed, panicked, anxious, or shock). The entire chest wall, musculature, breasts, sternum, xiphoid, and abdomen should be palpated in an attempt to identify the source and reproducibility of the pain. The
DIFFERENTIAL DIAGNOSIS
A detailed list of differential diagnoses for chest pain in children includes:
Cardiac (m = murmur present on auscultation)
Anatomic lesions
Aortic stenosis (m)
Aortic aneurysm with dissection (± m)
Subaortic stenosis (m)
Supravalvar aortic stenosis (m)
Ruptured sinus of Valsalva (m)
Coarctation of the aorta (m)
Anomalous left, right, or both coronary arteries from pulmonary artery (± m)
Coronary artery ostia stenosis or atresia
Intramural coronary artery
Left coronary artery
SUMMARY
Chest pain in the pediatric population is a common and mostly benign occurrence. A thorough history and physical examination are usually all that are necessary in excluding the rare, life-threatening causes of chest pain. These rare, life-threatening events require immediate evaluation, treatment, and subspecialty consultation. Idiopathic chest pain is the most common diagnosis, and the symptoms are typically chronic. Laboratory testing is usually nondiagnostic, costly, and burdensome to
ACKNOWLEDGMENT
The author would like to acknowledge the expert medical illustrations prepared by Robert Amaral, MA, from the University of Southern California School of Medicine.
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Cited by (0)
Address reprint requests to Keith C. Kocis, MD, MS, University of Southern California School of Medicine, Childrens Hospital Los Angeles, MS 66, 4650 Sunset Boulevard, Los Angeles, CA 90027
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University of Southern California School of Medicine, Children's Hospital, Los Angeles, California