Unexplained pediatric chest pain and rash

My son Ryan is 10 1/2 years old.  He was born with Tricuspid Valve Hypoplasia w/Stenosis & Regurgitation.  At 2 1/2 weeks, he had a Modified Right-Sided Blalock-Taussig shunt procedure.  At 6, he had a Catheterization and Angiography and Coil Embollization of his shunt.  He is on no meds or restrictions and sees his pediatric cardiologist annually.  On November 23, 2007 he began complaining of chest pains.  The pain seems to stay on his left side.  The pain can be in the front (close to the nipple area, not center of chest), the side, or the back (left side).  When the pain occurs, he also gets a very visible rash at the pain site.  This pain lasts approx. 10-15 minutes, and can come in waves (intense, then not so intense, intense, not so intense).  After the episode, when the pain subsides, the rash slowly disappears (after about 1/2 hour).  The pain can occur 3 times a day or 20 times a day.  Or not at all.  He has gone 3, 5 or even 12 days between pain episodes.  When the pain occurs, he can be screaming and crying.  Or he can be a bit more controlled and says the pain is a 7 out of 10.  As of last night, the pain has started to move into his upper left arm.  We haven't seen a rash on the arm, but he says it feels as if someone is squeezing the inside of his arm.  He has seen his pediatric cardiologist, a pediatric neurologist, a pediatric orthopedist, and a pediatric infectious disease specialist (not shingles related) (the last 2 at UW Madison).   He has had 2 sets of chest x-rays, bloodwork and a bone scan.  He is seeing his cardiologist tomorrow for his annual exam (I requested this early -normally due in April).  In the mean time, he has been given a prescription for Tylenol w/Codeine.  It might be taking the edge off, but he is still quite uncomfortable and the pain is beginning to affect his school attendance.  We don't know where else to turn.  Should we get a 2nd opinion on one of these specialists, or is there another specialty we need to look at?

[Kevin Pho, MD]

It is difficult to say without examination.  There clearly has been a comprehensive evaluation with multiple pediatric specialists at an academic medical center.

Neurology, cardiology and orthopedics have been involved.  

You can consider GI causes, as many diseases in this area have the potential to lead to chest discomfort.  If suspected, imaging with a CT scan or an upper endoscopy would be reasonable initial tests.

This can be discussed with your personal physician.  As for another opinion, a suggestion would be to travel to another academic medical center.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com