Fatal aortic rupture presenting as chest pain in an adolescent. The role of echocardiography in occult cystic medial necrosis

Chest pain in children and adolescents

The focus of this article is to explore chest pain in children and adolescents. Common causes of chest pain and the approach to its evaluation are reviewed. Special emphasis is given to the cardiac causes of pediatric chest pain and how it can be differentiated from more common benign etiologies.

Etiologic factors of acute aortic dissection in children and young adults

Current concepts in the pathophysiology and predisposing conditions of acute aortic dissection in children, adolescents, and young adults are presented. Timely diagnosis is required for this life-threatening condition. Most children and adolescents with aortic dissection have congenital cardiovascular anomalies. Certain heritable disorders involving connective tissue also predispose to this disorder. Newer associations include cocaine abuse and weight lifting. To facilitate early diagnosis, the salient physical findings of the known predisposing conditions are reviewed. Clinical presentation and diagnostic imaging of aortic dissection are briefly summarized. Physicians working in an acute care setting, particularly in the emergency room, should be aware of disorders predisposing to acute aortic dissection in the pediatric and young adult population. Practitioners conducting school or college preparticipation sports evaluations can make use of such information in their assessment of risk for sudden death.

Chest pain in pediatrics

Chest pain in the pediatric population is a common and mostly benign occurrence. A thorough history and physical examination are usually all that are necessary in excluding the rare, life-threatening causes of chest pain. These rare, life-threatening events require immediate evaluation, treatment, and subspecialty consultation. Idiopathic chest pain is the most common diagnosis, and the symptoms are typically chronic. laboratory testing is usually nondiagnostic, costly, and burdensome to patients and therefore unnecessary. A long-term, trusting relationship with the patients and their families is needed to reassure them and allow symptoms to resolve.