Causes of nontraumatic chest pain in children and adolescents

• Hypertrophic cardiomyopathy
• Aortic stenosis
• Coarctation of the aorta
• Coronary artery abnormalities (eg, Kawasaki disease, anomalous coronary arteries)
• Variant angina after recreational drug use (eg, cocaine, amphetamines, bath salts [methcanthinones], marijuana, and synthetic cannabinoids)
• Classic angina (early atherosclerotic disease from hyperlipidemias or diabetes mellitus)
• Pericarditis
• Myocarditis
• Dilated cardiomyopathy
• Tachyarrhythmias
• Aortic aneurysm or dissection
• Ruptured sinus of Valsalva aneurysm

Airway foreign body

Spontaneous pneumothorax

Pulmonary embolism

Pulmonary hypertension

Sickle cell disease with acute chest syndrome

Tumor (chest wall, pulmonary, or mediastinum)

Nontraumatic esophageal rupture (Boerhaave syndrome)

• Muscle strain
• Costochondritis
• Slipping rib syndrome
• Precordial catch (Texidor twinge)
• Fibromyalgia
• Pectus excavatum or carinatum

Psychiatric

• Anxiety
• Panic disorder with or without hyperventilation syndrome
• Depression
• Hypochondriasis
• Somatic symptom disorder

Respiratory

• Pneumonia (can be life threatening)
• Asthma (can be life threatening)
• Chronic cough with muscle strain or, if severe, fractured rib
• Spontaneous pneumomediastinum

Gastrointestinal

• Gastroesophageal reflux disease
• Medication-induced ("pill") esophagitis
• Esophageal foreign body
• Esophageal spasm and achalasia
• Gastritis
• Peptic ulcer
• Irritable bowel disease
• Cholecystitis
• Pancreatitis

Breast

• Male adolescents: Gynecomastia
• Female adolescents: Pregnancy, thelarche, mastitis, or fibrocystic disease

Idiopathic

Tietze syndrome

Pleurodynia