What causes chest pain despite a normal chest X-ray report?
Patient: My son is 17 and has experienced chest pain ,what he calls palpitations, when he exerts himself for about a year now. He has seen a cardiologist and had a holter monitor and just had a stress test (which he was unable to reproduce his symptoms because he also has compartment syndrome of BLE and was only able to tolerate 8 min of test. Cardiologist thinks it is NOT cardiac related. A recent chest xray to r/o pneumonia was negative for any abnormalities of the chest, ribs, sternum. Could this be musculskeletal? Where else should we be looking? Doctor: Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.  I need to know more about the symptoms, like precipitating factors, factors that increases pain etc. It can be a gastritis and reflux disease. Do you upper abdominal pain, nausea, bloating, burping, increase in pain on food, sour water feeling in throat or chest burning, if yes it further supports the diagnosis. Secondly does this pain increases on applying pressure over the area, if yes it could be costochondritis and it's a musculoskeletal type of pain and needs prolonged nsaid therapy. Does this pain increases on deep breathing and coughing etc. if yes it a pain arising from lining of lungs and needs nsaids treatment and evaluation.  Hope I have answered your query. Let me know if I can assist you further.