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ORIGINAL ARTICLE
Korean J Pediatr 2015 November;58(11) :440-445.
Published online 2015 November 15.       
Analysis of clinical characteristics and causes of chest pain in children and adolescents
Ji Hye Chun1, Tae Hyeong Kim1, Mi Young Han2, Na Yeon Kim3, Kyung Lim Yoon1
1Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea
2Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
3Department of Psychology, Chung Ang University, Seoul, Korea
Corresponding Author: Kyung Lim Yoon ,Tel: +82-2-440-7000, Fax: +82-2-440-7175, Email: ykr3215@hanmail.net
Copyright © 2015 by The Korean Pediatric Society
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.
Keywords: Chest pain | Child | Adolescent | Musculoskeletal diseases
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