A 14-year-old girl presents with chest pain associated with coughing; tenderness is noted over several ribs with no cardiopulmonary abnormal findings. What is the appropriate initial management?

A 14-year-old girl presents with chest pain associated with coughing; tenderness is noted over several ribs with no cardiopulmonary abnormal findings. What is the appropriate initial management?

• A. Chest radiograph
• B. ECG
• C. NSAIDs, stretching, and ice
• D. Refer to a pediatric orthopedist

Answer: (C)

Adolescent chest wall pain with coughing and tenderness over several ribs, in the absence of cardiopulmonary abnormalities, is most consistent with a benign musculoskeletal issue such as a rib strain or costochondral inflammation from coughing. Because the exam and history don’t suggest heart or lung disease, the initial approach is conservative rather than diagnostic testing. NSAIDs help reduce inflammation and pain, stretching can relieve chest wall muscle tension, and ice can ease local tenderness. This minimizes unnecessary radiation exposure from imaging and avoids unnecessary procedures. A chest radiograph isn’t needed unless there is a history of significant trauma, persistent focal tenderness suggesting a fracture, or new signs point toward a cardiopulmonary problem; an ECG isn’t indicated without symptoms or findings suggesting cardiac involvement; and referral to a pediatric orthopedist isn’t required initially unless pain persists or worsens despite conservative care.

Adolescent chest wall pain with coughing and tenderness over several ribs, in the absence of cardiopulmonary abnormalities, is most consistent with a benign musculoskeletal issue such as a rib strain or costochondral inflammation from coughing. Because the exam and history don’t suggest heart or lung disease, the initial approach is conservative rather than diagnostic testing. NSAIDs help reduce inflammation and pain, stretching can relieve chest wall muscle tension, and ice can ease local tenderness. This minimizes unnecessary radiation exposure from imaging and avoids unnecessary procedures. A chest radiograph isn’t needed unless there is a history of significant trauma, persistent focal tenderness suggesting a fracture, or new signs point toward a cardiopulmonary problem; an ECG isn’t indicated without symptoms or findings suggesting cardiac involvement; and referral to a pediatric orthopedist isn’t required initially unless pain persists or worsens despite conservative care.