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Symptoms and Signs – Differential Diagnosis of Chest Pain in Children MUSCULOSKELETAL (COMMON) • Trauma (accidental, abuse) • Exercise, overuse injury (strain, bursitis) • Costochondritis (Tietze’s syndrome) • Herpes zoster (cutaneous) • Pleurodynia • Fibrositis • Slipping rib • Sickle cell anemia vaso-occlusive crisis • Osteomyelitis (rare) • Primary or metastatic tumor (rare) PULMONARY (COMMON) • Pneumonia • Pleurisy • Asthma • Chronic cough • Pneumothorax • Infarction (sickle cell anemia) • Foreign body • Embolism (rare) • Pulmonary hypertension (rare) • Tumor (rare) GASTROINTESTINAL (LESS COMMON) • Esophagitis (gastroesophageal reflux) • Esophageal foreign body • Esophageal spasm • Cholecystitis • Subdiaphragmatic abscess • Perihepatitis (Fitz-Hugh–Curtis syndrome) • Peptic ulcer disease CARDIAC (LESS COMMON) • Pericarditis • Postpericardiotomy syndrome • Endocarditis • Mitral valve prolapse • Aortic or subaortic stenosis • Arrhythmias • Marfan syndrome (dissecting aortic aneurysm) • Anomalous coronary artery • Kawasaki’s disease • Cocaine, sympathomimetic ingestion • Angina (familial hypercholesterolemia) IDIOPATHIC (COMMON) • Anxiety, hyperventilation • Panic disorder OTHER (LESS COMMON) • Spinal cord or nerve root compression • Breast-related pathologic condition • Castleman’s disease (lymph node neoplasm) 
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