From the Guidelines
Precordial catch syndrome (PCS) in a 10-year-old typically presents as sharp, stabbing chest pain that occurs suddenly, usually on the left side of the chest, and is characterized by pain that worsens with deep breathing, lasts for 30 seconds to 3 minutes, and resolves spontaneously without intervention. The child will likely be otherwise healthy with no other concerning symptoms like fever, shortness of breath, dizziness, or syncope 1. Physical examination should be completely normal, with no abnormalities in heart rate, blood pressure, heart sounds, or respiratory function.
Key Features to Look for in PCS
- Sharp, stabbing chest pain that occurs suddenly
- Pain usually on the left side of the chest
- Pain worsens with deep breathing
- Pain lasts for 30 seconds to 3 minutes
- Pain resolves spontaneously without intervention
- No other concerning symptoms like fever, shortness of breath, dizziness, or syncope
- Normal physical examination with no abnormalities in heart rate, blood pressure, heart sounds, or respiratory function No specific testing is required if the presentation is classic. PCS is benign and self-limiting, requiring only reassurance and education 1. No medications are typically needed, though you can suggest shallow breathing during episodes to reduce pain. If the child experiences atypical features such as pain lasting longer than a few minutes, pain with exertion, associated symptoms like syncope or palpitations, or abnormal physical exam findings, further cardiac evaluation would be warranted, as exertional syncope is associated with a considerably greater likelihood of cardiac disease 1. PCS is thought to be caused by a pinched nerve or muscle spasm in the chest wall and has no long-term health consequences.
From the Research
Clinical Features of Precordial Catch Syndrome (PCS)
The clinical features of PCS in a 10-year-old can be identified through a careful history and physical examination. The key characteristics of the pain in PCS include:
- Sudden onset 2
- Brief duration 2
- Periapical location 2
- Easily localized 2
- Nonradiating 2
- Nonexertional 2
- Intensified by inspiration 2
Diagnostic Approach
A detailed history eliciting these diagnostic features, along with a physical examination excluding other pathologic disorders, is essential for diagnosis 3, 4. Diagnostic testing is usually unnecessary 4, but may be considered if other cardiac or non-cardiac causes of chest pain are suspected 5, 6.
Differential Diagnosis
PCS is a benign cause of chest pain in children and adolescents, but it is often underrecognized 3, 4. Other causes of chest pain, such as musculoskeletal disorders, idiopathic chest pain, and cardiac disorders, should be considered in the differential diagnosis 5. However, cardiac aetiologies for paediatric chest pain are very rare, and a careful history and physical examination can often provide reassurance 5.