Differential Diagnosis for the 11-year-old boy
Single most likely diagnosis
- Traumatic aortic injury or rupture is unlikely in this age group, but a more plausible diagnosis is a traumatic injury to the thoracic outlet or a fracture/dislocation of the sternoclavicular joint. The symptoms of upper chest pain, dyspnea, and mild neck vein engorgement, along with a swollen sternoclavicular joint, support this diagnosis. The mechanism of injury, being tackled and landing on his shoulder, also aligns with this possibility.
Other Likely diagnoses
- Pneumothorax: The complaint of dyspnea and upper chest pain could suggest a pneumothorax, especially if the trauma caused a lung injury. However, the absence of more specific symptoms like decreased breath sounds on one side makes this less likely.
- Clavicle fracture: Given the mechanism of injury and the location of pain, a clavicle fracture is a possibility. However, the specific mention of sternoclavicular joint swelling points more towards an injury in that area.
- Rib fracture: Rib fractures could cause chest pain and dyspnea, but the swelling of the sternoclavicular joint and neck vein engorgement are not typical findings for isolated rib fractures.
Do Not Miss diagnoses
- Traumatic aortic injury: Although less common in children and not the most likely diagnosis given the age and specific symptoms, a traumatic aortic injury is a potentially life-threatening condition that must be considered, especially with symptoms of chest pain and dyspnea after trauma.
- Pulmonary contusion: This could present with dyspnea and chest pain, and while it's not directly suggested by the sternoclavicular joint findings, it's a serious condition that requires consideration in the context of trauma.
- Hemothorax or hemopneumothorax: These conditions could explain the dyspnea and chest pain, and while they might not directly relate to the sternoclavicular joint swelling, they are critical to identify due to their potential severity.
Rare diagnoses
- Thoracic outlet syndrome (TOS) due to trauma: While TOS can cause arm pain, numbness, and weakness, and sometimes chest pain, it's less commonly considered in the acute setting of trauma, especially in children.
- Diaphragmatic rupture: This is a rare injury that could potentially cause chest pain and dyspnea, but it would more commonly be associated with abdominal symptoms or findings suggestive of diaphragmatic hernia.