Korean J Pediatr.  2015 Nov;58(11):440-445. 10.3345/kjp.2015.58.11.440.

Analysis of clinical characteristics and causes of chest pain in children and adolescents

• Chun JH
• Kim TH
• Han MY
• Kim NY
• Yoon KL

• KMID: 2129737
• DOI: http://doi.org/10.3345/kjp.2015.58.11.440

Abstract

PURPOSE
Chest pain is common in children and adolescents and is a reason for referral to pediatric cardiologists. Although most cases of chest pain in these age groups are benign and do not require treatment, timely diagnosis is important not to miss life-threatening diseases requiring prompt treatment. We investigated certain clinical characteristics that may be useful in the diagnosis of such critical diseases.
METHODS
Patient medical records between July 2006 and September 2013 were retrospectively examined. We included 517 patients who presented with chest pain to the Department of Pediatrics at Kyung Hee University Hospital in Gangdong.
RESULTS
Most cases of chest pain were idiopathic in origin (73.6%), followed by cases with respiratory (9.3%), musculoskeletal (8.8%), cardiac (3.8%), gastrointestinal (2.9%), and psychiatric (1.4%) causes. In 6 patients (1.2%) with air-leak syndrome including pneumothorax or pneumomediastinum, the pain was abrupt, continuous, and lasted for a short period of 1-2 days after onset in the older adolescents. Of the patients with cardiac pain, 13 had cardiac arrhythmias (65.0%), 6 had congenital heart diseases (30%), and 1 had coronary aneurysms caused by Kawasaki disease (5.0%). One patient with atrial flutter had only symptoms of syncope and chest pain.
CONCLUSION
The abrupt, continuous chest pain of a short duration in the older children was characteristic of air-leak syndrome. In patients with pneumomediastinum, radiological diagnosis was difficult without careful examination. Combined syncope should not be neglected and further cardiac workup is essential in such patients.

Keyword

Chest pain; Child; Adolescent; Musculoskeletal diseases

MeSH Terms

Adolescent*
Arrhythmias, Cardiac
Atrial Flutter
Chest Pain*
Child*
Coronary Aneurysm
Diagnosis
Heart Diseases
Humans
Mediastinal Emphysema
Medical Records
Mucocutaneous Lymph Node Syndrome
Musculoskeletal Diseases
Pediatrics
Pneumothorax
Referral and Consultation
Retrospective Studies
Syncope
Thorax*