Chest Pain in Children and Adolescents

Case Studies Case 1 During an annual physical examination, a 12-year-old girl complains of intermittent chest pain for the past 5 days that localizes to the left upper sternal border. The pain is sharp and stabbing, is 5/10 in intensity, increases with deep breathing, and lasts for less than 1 minute. The patient has no history of fever, cough, exercise intolerance, palpitations, dizziness, or syncope. On physical examination, the young girl is in no pain or distress and has normal vital signs for her age. Examination of her chest reveals no signs of inflammation over the sternum or rib cage. Palpation elicits mild-to-moderate tenderness over the left second and third costochondral junctions. The patient reports that the pain during the physical examination is similar to the chest pain she has experienced for the past 5 days. A detailed cardiovascular and other organ system examination yields normal results. What is the most likely cause of this patient’s chest pain? What will you recommend for this patient? Does she need to see a pediatric cardiologist?