Differential Diagnosis for a 16-year-old with Chest Pain
Single Most Likely Diagnosis
- Musculoskeletal Chest Pain: This is the most common cause of chest pain in adolescents, often related to strain or overuse of the muscles and bones in the chest wall. The pain is typically sharp, localized, and reproducible with movement or palpation.
Other Likely Diagnoses
- Asthma or Reactive Airway Disease: Chest pain can be a symptom of asthma or other respiratory conditions, especially if the pain is associated with wheezing, coughing, or shortness of breath.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain that is often described as burning and may be accompanied by symptoms like heartburn and regurgitation.
- Precordial Catch Syndrome: A benign condition characterized by sharp, stabbing chest pain that can be quite frightening but is not associated with any serious underlying condition.
Do Not Miss Diagnoses
- Myocardial Infarction (MI): Although rare in adolescents, MI can occur, especially in those with underlying heart conditions or risk factors such as familial hypercholesterolemia.
- Pulmonary Embolism (PE): A potentially life-threatening condition that can cause sudden onset of chest pain, often accompanied by shortness of breath and possibly syncope.
- Pneumothorax: A condition where air leaks into the space between the lung and chest wall, which can cause sudden, severe chest pain and shortness of breath.
- Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, which can cause sharp, stabbing chest pain that may improve with leaning forward.
Rare Diagnoses
- Hypertrophic Cardiomyopathy: A condition where the heart muscle becomes thickened, which can lead to obstruction of blood flow and increase the risk of sudden cardiac death.
- Marfan Syndrome: A genetic disorder that affects the body's connective tissue, which can lead to problems with the heart, including aortic dissection or rupture.
- Spontaneous Coronary Artery Dissection (SCAD): A rare condition where there is a tear in the coronary artery, which can lead to a heart attack.
- Tietze's Syndrome: A rare inflammatory condition that affects the cartilages and surrounding tissues of the ribs, causing chest pain and swelling.