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Chest Pain in a Tween: Seen in the ED


The 11-year-old girl has had a fever up to 102.1°F for 3 days and midsternal nonpleuritic chest pain for 1 day. What tests would you order? Your Dx?

Chest pain in a tween: seen in the ED / image credit D Brady Pregerson, MD

D Brady Pregerson, MD

History of present illness. An 11-year-old fully vaccinated girl with no significant past medical history is brought by her parents to the emergency department for 3 days of fever up to 102.1°F and generalized headache and 1 day of midsternal non-radiating, non-exertional, non-pleuritic chest pain. She denies any runny nose, cough or sore throat, as well as any vomiting, neck stiffness or photophobia but says the chest pain is “really bad.”

Vital signs and physical examination: Vital signs are normal except for temperature of 99.9°F and a pulse of 108 beats/min. Physical exam is otherwise normal including clear lungs and no murmurs or rubs and no peripheral edema.

Results of initial diagnostic testing:

CBC: normal except for 77% PMNs

Chem 7: normal

Other: EKG and chest x-ray both normal

What additional testing should you consider? (More than one option may be appropriate)

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