Pediatric clinics of North America
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This article discusses pneumothorax, pneumomediastinum, and pulmonary embolism in pediatric practice. Although children appear to have better outcomes than adults, the risk factors are substantial. Topics covered include the pathophysiology incidence, presentation, diagnosis, and management of these diseases.
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Children frequently present to a pediatric office or emergency department with the complaint of chest pain. Between 0.3% and 0.6% of visits to a pediatric emergency department are for chest pain. ⋯ Infrequently, a child with chest pain will present with significant distress and require immediate resuscitation. Most children with chest pain are not in extremis, and for many, the pain is not acute in nature.
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Musculoskeletal chest pain is the most common identifiable cause of chest pain in children and adolescents. A lesion or irritation of any layer of the anterior chest wall may lead to pain. ⋯ Regardless of the cause, chest pain raises concern of cardiac abnormalities, and may rapidly lead to significant anxiety and lifestyle alterations. Thus, efficient and accurate identification of the cause of pediatric chest pain by a thorough history and physical examination is important to minimize the disruption it may cause.
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Myocarditis and pericarditis are rare but important causes of pediatric chest pain. The diagnostic criteria, clinical course, causes, and treatment of myocarditis is reviewed. ⋯ The identification and treatment of pericarditis with associated large pericardial effusion can be lifesaving. This article reviews the important clinical features that might lead the clinician to diagnose either myocarditis or pericarditis and thus separate the few patients with either of these conditions from the legions of children with noncardiac chest pain.