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An unusual cause of chest pain in a teenage girl
  1. Ben McNaughten,
  2. Andrew Thompson,
  3. Dara O'Donoghue
  1. Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Ben McNaughten, Royal Belfast Hospital for Sick Children, Clinical Fellow, Falls Road, Belfast BT12 6BA, UK; bmcnaughten095{at}hotmail.com

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A 13-year-old girl presented with a 3-day history of worsening paroxysmal cough and vomiting. She also described chest pain over the preceding 3 weeks. These acute symptoms occurred on a background of cough, dyspnoea and weight loss over a 2-month period. She had no significant past medical history. On examination, she was afebrile, pale and lethargic. Her respiratory rate was 22 breaths/min , oxygen saturations were 91% in room air and heart rate was 88 beats/min. Air entry was good throughout and there was no wheeze on auscultation. A chest X-ray performed 1 month previously was normal. A repeat chest X-ray was requested (figure 1).

Figure 1

Chest X-ray on admission.

Questions

  1. What abnormalities are visible on the chest X-ray?

  2. What is the most likely diagnosis?

    1. Asthma

    2. Gastro-oesophageal reflux disease

    3. Infection

    4. Malignancy

    5. Metabolic bone disease …

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