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pain when no organic etiology and no psychological factors are present to explain the pain It is typically described as occasional short episodes of sharp chest pain with or without exercise and no other associated symptoms Physical examination is completely normal and pain is not reproducible Precordial catch syndrome or “Texidor’s twinge” is a relatively frequent cause of chest pain in healthy teenagers and young adults It typically presents with an acute, sharp, welllocalized pain (often in the left substernal region) that has a “split second” onset, is of short duration, worsened by deep inspiration, and usually occurs at rest or related to exercise It is often relieved by position change (sitting up straight) which suggests that posture or ligamentous stretching of the supporting ligaments of the heart may have a role but the true etiology is unknown The physical examination is normal without reproducible pain Other causes of chest pain include male adolescents with gynecomastia and female patients with fibrocystic breast disease Rarely, chest pain, pressure, or shortness of breath, worse on supine position, will be associated with the presentation of a mediastinal mass EVALUATION AND DECISION Child With Thoracic Trauma The first step in evaluation of the child with chest pain is to perform a thorough history and physical examination If the history is positive for a traumatic injury or there is any evidence of trauma to the chest (see Chapter 115 Thoracic Trauma ), the patient requires rapid evaluation and may need immediate resuscitation as well ( Fig 55.1A ) Correction of cardiac or respiratory insufficiency may diagnose and treat the cause of chest pain Alveolar ventilation should be assessed for adequacy and bilateral symmetry to distinguish acute respiratory failure from hemothorax or pneumothorax In children with chest trauma, tachycardia with hypotension is generally caused by hypovolemia secondary to a hemothorax, hemopneumothorax, or vascular injury Reduced cardiac output and perfusion, however, may also be secondary to a rhythm disturbance (from a myocardial contusion or tension pneumothorax) or cardiac tamponade (which causes muffling of the heart sounds and pulsus paradoxus) A discrepancy of the pulse or blood pressure between the extremities points to aortic diseases, such as traumatic avulsion or aneurysm Ruptured esophagus and tracheobronchial disruption may result from rapid deceleration injuries and may present with chest pain, subcutaneous emphysema, respiratory distress, and hypotension
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