A 13-Year-Old Athlete With Chest Pain, Cough After Practice

Daniel Beardmore, DO; Sonika Loona, MD; Mia Mallon, MD


March 01, 2022

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A 13-year-old athletic boy with no significant past medical history is transferred from a nearby suburban emergency department (ED) to an urban children's hospital for inpatient management of pneumomediastinum. On the day before transfer, he was physically active, participating in a track meet and then soccer practice immediately afterward. After the track meet finished, he began to have some mild chest pain, which increased during his soccer practice. During this second activity, he did not have to stop because of the pain but noted progressively worsening pain during "deep breathing." The night before presentation, he had increasing pain in his chest, making sleep difficult.

He describes the pain as dull, located in the substernal region, extending into his neck, aggravated by deep breaths, and alleviated with rest. He does not have any dyspnea, wheezing, palpitations, dizziness, headache, sweating, or abdominal pain. He describes a mild, intermittent dry cough, which has mostly dissipated since resolution of an upper respiratory infection about 3 weeks ago.

The patient lives at home with his immediate family in a suburban area. His social history includes no smoke exposure or significant travel history, and his immunizations, including an annual influenza vaccination and COVID-19 vaccination with booster, are up to date. Family medical history is noncontributory and includes no history of asthma, heart disease, blood clots, or sudden/early death.


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