F Empyema G Pneumomediastinum H Malignancy/mediastinal mass I Postpericardiotomy syndrome J Pulmonary embolus/infarction K Vasoocclusive crisis (sickle cell anemia) L Tumor M Subphrenic abscess/hepatic abscess N Late presentation of congenital diaphragmatic hernia O Fitz-Hugh–Curtis syndrome IV Gastrointestinal A Esophageal Foreign body Caustic ingestion Gastroesophageal reflux/esophagitis Esophageal spasms Infection—Candida Esophageal rupture/tear B Hiatal hernia C Gastritis/peptic ulcer disease D Cholecystitis E Pancreatitis V Cardiac (angina, pericardial, aortic) A Angina—coronary insufficiency, a anomalous vessels, pulmonary hypertension B Hypertrophic cardiomyopathy C Aortic stenosis, pulmonary stenosis D Asymmetric septal hypertrophy E Pericardial defects and effusions, pericarditis F Acute arrhythmias a G Myocarditis a H Aortic aneurysm—idiopathic, syphilitic, Marfan syndrome I Mitral valve prolapse VI Central A Psychiatric—anxiety, hyperventilation, conversion reaction, depression, phobia B Idiopathic—Texidor twinge (precordial catch) C Other—visceral pain–associated disability syndrome a Associated drug induced (especially cocaine) TABLE 55.2 COMMON CAUSES OF CHEST PAIN Functional (anxiety/psychosomatic) Musculoskeletal contusion/strain Costochondritis/myositis Cough or respiratory infections (bronchitis, pneumonia, pleurisy, upper respiratory infections) Asthma Gastroesophageal reflux Idiopathic TABLE 55.3 LIFE-THREATENING CAUSES OF CHEST PAIN Category Disease/injury Decompensation Traumatic Rib fracture Tension pneumothorax or shock from hemothorax Arrhythmia or myocardial infarction Shock Cardiac contusion Laceration—heart or great vessel Contusion—great vessels Pulmonary contusion Dissecting aneurysm/shock Adult respiratory distress syndrome Arrhythmia, shock, pulmonary hypertension Arrhythmia, cardiogenic shock Cardiac Congenital heart disease Pulmonary Myocardial infarction (anomalous coronary artery, Kawasaki disease, cocaine toxicity) Myocarditis Arrhythmia, cardiogenic shock Pericarditis Tamponade Rheumatic heart disease Arrhythmia, congestive heart failure Aortic aneurysm Rupture-shock, dissection Obstructive cardiac disease Acute hypertension Pneumothorax (asthma, cystic Tension pneumothorax, fibrosis, spontaneous) pulmonary hypertension, shock Hemothorax Shock, hypoxemia Pulmonary infection or Pulmonary hypertension, empyema sepsis Aspiration—foreign body Acute airway obstruction, progressive pulmonary hypertension Acute asthma Tension pneumothorax, pulmonary hypertension