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Asthma

Lung Scarring and Chest Pain

02/16/2007

Question:

My 11 year old daughter complains of pain in the chest on the left side after a high impact soccer work out. The pain starts when they do running wind sprints.

We`ve had the full battery of heart and lung tests and all have come back normal. She has a very small heart murmur which doctors beleive is not the cause of the pain.

She had pnemonia 2 years ago and we were wondering if scarring on the lung could be causing the pain we she`s breathing heavily?

Answer:

Chest pain in child athletes is, fortunately, much less often a sign of a serious underlying condition (like coronary artery disease) than it is in adults.  Because pain over the left chest triggers worry about the heart, however, cardiac evaluation is often one of the first things people check.  Our cardiologists will sometimes recommend an exercise study, which includes testing for exercise induced bronchospasm (EIB), as part of their work-up.  (This involves not only cardiac monitoring during the exercise test, but also pre-exercise lung function tests, followed by a series of lung function tests after exercise.)  Deterioration of lung function numbers after exercise indicates the presence of EIB - an asthma-like problem which can sometimes cause symptoms of chest pain without any other "clues" like cough or wheeze.  Asthma medications can help stop this problem.

If the battery of tests your daughter has undergone has already included an exercise test - especially if she had the pain during the test - and no signs of EIB were found, then that's less likely to be the problem.  (If your daughter had normal breathing tests - but they were all done while she was resting - they could miss this problem.)

Lung tissue has very few nerves that register "pain" - EXCEPT for the layer of tissue that surrounds the outside of the lung, and the inside of the chest cavity (the pleura).  If the previous pneumonia spread all the way out to this lining tissue (which would have caused pain during the original infection - i.e. pleurisy), then perhaps some scar left in the area could still be an area that gets irritated during vigorous breathing.  Pain involving the pleura is notoriously linked to breathing - it increases and decreases as a person breathes in and out.

People now believe that a "side stitch," which is common in runners and tends to involve pain along the lower ribs/upper abdomen, is caused by a spasm of the diaphragm muscle, or by yanking on the ligaments between the diaphragm and the organs below (liver on the right, stomach on the left).  If your daughter's pain is in the lower part of the chest, perhaps this may be the cause.  A variety of remedies are mentioned in sports literature, including things like avoiding running with a full (heavy) stomach, and taking even, deep, breaths while running. 

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Response by:

Elizabeth D Allen, MD Elizabeth D Allen, MD
Clinical Associate Professor of Pediatrics
College of Medicine
The Ohio State University