Differential Diagnosis for a 7-year-old with Chest Pain and Shortness of Breath
Single Most Likely Diagnosis
- Asthma: This is a common condition in children that can cause chest pain and shortness of breath, especially with exertion. The symptoms of low exercise tolerance for several months also align with asthma, as it can limit a child's ability to participate in physical activities due to respiratory symptoms.
Other Likely Diagnoses
- Anxiety or Panic Disorder: Chest pain and shortness of breath can be symptoms of anxiety or panic attacks in children. Given the psychological impact of the pandemic and other stressors, this is a plausible diagnosis.
- Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain in children, and while it might not directly cause shortness of breath, it could contribute to discomfort that worsens with exertion.
- Pneumonia or Other Respiratory Infections: Although the child does not have a cough or fever, atypical presentations can occur, especially in children.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although rare in children, pulmonary embolism is a life-threatening condition that requires immediate attention. Risk factors such as recent travel, immobilization, or family history of clotting disorders would increase suspicion.
- Cardiac Conditions (e.g., Hypertrophic Cardiomyopathy, Coronary Artery Anomalies): Despite no history of congenital heart disease, new-onset cardiac issues can arise, and chest pain with exertion is a red flag symptom.
- Pneumothorax: Spontaneous pneumothorax can occur without a clear trauma history and would explain both chest pain and shortness of breath.
Rare Diagnoses
- Cystic Fibrosis: A genetic disorder that leads to severe respiratory and digestive problems. It could explain chronic shortness of breath and low exercise tolerance but would typically be accompanied by other symptoms like recurrent infections or gastrointestinal issues.
- Primary Pulmonary Hypertension: A rare but serious condition that can cause shortness of breath and chest pain due to high blood pressure in the lungs' arteries.
- Sickle Cell Disease: If the child has sickle cell disease, chest pain could be due to a sickle cell crisis, which can also cause shortness of breath due to acute chest syndrome.