Question Hello, my 15 yr old daughter has been experiencing chest pains for about a month. She had an x-ray and looked ok but we are worried it could be bone cancer or something like that. She has also, in the past week, had pains all over her body- from her wrist to her legs and neck. What could this be? thanks
Answer Hello Sophie,
Thank you for the question. I apologize for the delay in my response, I have been out of town and forgot to notify the site.
Adolescent chest pain is common, particularly in girls. Of those patients who experience it greater than 50% of them will have symptoms more than two times per week. Psychological stress seems to play the biggest role in adolescent chest pain. In fact, stressful events, such as a death in the family, major illness, an accident, family separations, and school changes may contribute significantly. This is not to discount your daughter’s symptoms, because they are very real to her. But may be reassuring to you. I have found that it is most common in these situations that there is a physical as well as a potential psychological component. That is to say if an adolescent has an underlying issue that might cause chest pain, that psychological stress would exacerbate or initiate it.
By far the most common physiologic diagnosis for adolescent female chest pain are musculoskeletal problems. That would include costochondritis, a form of inflammation, of the ribs and cartilage where they meet in the anterior chest. This is relatively easy to discern as the adolescent will have pain upon applied pressure to the anterior chest wall. The presence of pain is a very reassuring sign. Because this suggests that the pain is outside of the thoracic cavity and is mechanical, versus being deep in the thoracic cavity, which contains major organs such as the heart, lungs and great vessels.
Hyperventilation alone can account for up to 20% of cases. 5% of adolescent girls with chest pain have breast-related problems.
Many cases of adolescent chest pain are never clearly diagnosed. However, serious underlying illness (such as bone cancer, which you had mentioned) is rarely cause of chest pain in this group.
Chest pain is a prevalent problem that is usually benign but is commonly misunderstood and creates considerable anxiety in adolescents and their families.
Any significant bone lesions that might represent malignancies should easily be seen on chest x-ray. You mentioned that your daughter has a negative (without problems) chest film. This should also be very reassuring.
Further evaluation would be warranted if she experiences changes in her vital signs while experiencing the symptoms or if her skin color changes dramatically. My overall impression, however, is that it is difficult being a 15 year-old girl and that the associated stresses may exacerbate or even initiate chest pain. Reassurance of your daughter, and potentially evaluating her psychological stressors might be a good place to begin.
Thank you the question. Again, I apologize for the delay in my response.
