What are the differential diagnoses for chest pain in adolescents?

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Last updated: May 18, 2025 • View editorial policy

Chest Pain Differential Diagnosis in Teenagers

When evaluating chest pain in teenagers, it's crucial to consider a wide range of potential causes due to the broad differential diagnosis. The following categorization helps in prioritizing the diagnostic approach:

  • Single Most Likely Diagnosis

    • Musculoskeletal Chest Pain: This is the most common cause of chest pain in teenagers, often related to strain or overuse of the chest wall muscles, costochondritis (inflammation of the cartilage that connects the ribs to the breastbone), or other musculoskeletal issues. The pain is typically sharp, localized, and reproducible with movement or palpation.
  • Other Likely Diagnoses

    • Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that may be mistaken for cardiac issues. It's often described as a burning sensation and can be associated with eating, lying down, or regurgitation.
    • Asthma or Other Respiratory Conditions: Conditions like asthma, bronchitis, or pneumonia can cause chest pain, especially if associated with coughing or difficulty breathing.
    • Anxiety or Panic Attacks: Teenagers can experience anxiety or panic attacks, which may manifest as chest pain or discomfort, often accompanied by other symptoms like palpitations, shortness of breath, or fear of dying.
  • Do Not Miss Diagnoses

    • Myocardial Infarction (MI) or Cardiac Issues: Although rare in teenagers, MI or other cardiac conditions like hypertrophic cardiomyopathy can occur and are potentially life-threatening. Risk factors include family history of early cardiac disease, drug use (e.g., cocaine), or pre-existing heart conditions.
    • Pulmonary Embolism (PE): PE is rare in teenagers but can be fatal if not recognized. It's more likely in those with a history of deep vein thrombosis, recent surgery, immobilization, or genetic predispositions to clotting.
    • Pneumothorax: A collapsed lung can cause sudden, severe chest pain and shortness of breath. It's more common in tall, thin males or those with underlying lung disease.
  • Rare Diagnoses

    • Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain that improves with sitting up and leaning forward. It's often associated with viral infections.
    • Pneumomediastinum: Air in the mediastinum can cause chest pain and is often related to asthma, inhalational drug use, or traumatic injuries.
    • Spontaneous Coronary Artery Dissection (SCAD): A rare condition where there is a tear in the coronary artery, which can lead to a heart attack. It's more common in young women, especially during pregnancy or postpartum.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and appropriate diagnostic tests to ensure accurate diagnosis and timely treatment.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.