Differential Diagnosis for Sharp Chest Pains in an 11-Year-Old Female
Single Most Likely Diagnosis
- Musculoskeletal Chest Pain: This is the most common cause of chest pain in children and adolescents, often related to strain or overuse of the chest muscles or costochondritis (inflammation of the cartilage that connects the ribs to the breastbone). The normal vitals and the sharp nature of the pain support this diagnosis.
Other Likely Diagnoses
- Anxiety or Panic Attack: Children can experience anxiety or panic attacks that manifest as sharp chest pains, especially if they have a history of anxiety disorders. The normal vitals in the ED support this possibility.
- Gastroesophageal Reflux Disease (GERD): GERD can cause sharp chest pains, especially after eating or at night, due to stomach acid flowing back into the esophagus.
- Precordial Catch Syndrome: This condition involves sharp, stabbing pains in the chest that can be related to the movement of the ribs or the diaphragm. It's more common in adolescents.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although rare in children, a pulmonary embolism can be life-threatening and must be considered, especially if there's a history of recent trauma, surgery, or known clotting disorders.
- Myocardial Infarction or Cardiac Issues: While extremely rare in children, cardiac issues such as myocardial infarction or myocarditis (inflammation of the heart muscle) can occur and are critical to identify early.
- Pneumothorax: A collapsed lung can cause sharp chest pain and, although less common in children without underlying lung disease, it's a condition that requires immediate attention.
Rare Diagnoses
- Pericarditis: Inflammation of the pericardium (the sac surrounding the heart) can cause sharp chest pains that may improve with leaning forward. It's less common in children but can be associated with viral infections or autoimmune diseases.
- Spontaneous Pneumomediastinum: This rare condition involves air leaking into the space between the lungs and can cause sharp chest pains, often in tall, thin adolescents.
- Thoracic Aortic Dissection: An extremely rare but life-threatening condition where there is a tear in the aorta's inner layer. It's more commonly associated with genetic conditions affecting the aorta or high blood pressure.