ABSTRACT

This case report presents a rare case of precordial catch syndrome (Texidor’s twinge) in an 8-year-old female who presented with four episodes of chest pain in the left side (needle like pain in heart area) in the last 2 years. The initial assessments revealed no abnormalities, including physical examination, ECG, chest CT, and brain MRI.

Her prolonged 90-minute episode of sharp stabbing pain in chest that comes and goes subsided with lying down and practicing deep breathing.

INTRODUCTION

Precordial Catch Syndrome (PCS), first described by Miller and Texidor in 1955, is a relatively uncommon but benign cause of chest pain, often overlooked in the differential diagnosis. It is frequently seen in children and adolescents but can also affect adults.

Precordial chest pain is characterized by sudden, sharp, stabbing pain localized to the intercostal spaces (the area between the ribs), most often on the left side of the chest. These episodes are typically brief, lasting only a few seconds to a few minutes. But in some cases, they can be prolonged. The pain is often triggered or aggravated by deep breathing, sudden movements, or changes in posture, leading to the belief that it may result from irritation or compression of the intercostal nerves.

The hallmark feature of precordial catch syndrome is that the pain is usually relieved by specific maneuvers such as deep breathing, lying down, or changing posture. This suggests that the discomfort may be related to musculoskeletal or nerve irritation rather than a severe underlying medical condition.

Although PCS can be alarming due to the intensity of the pain, it is self-limiting and typically resolves without the need for medical treatment. Nevertheless, its similarity to other potentially serious conditions, such as cardiovascular, respiratory, or gastrointestinal issues, often prompts comprehensive diagnostic evaluations to rule out other causes of chest pain.

PATIENT PROFILE

Diagnosis: Precordial catch syndrome (Texidor’s twinge)
Age: 8 years old
Clinical Background: The patient reported a 4th episode of severe, non-radiating left-sided chest pain lasting 90 minutes. Previous episodes, occurring over the past 2 years, lasted 10–15 minutes and resolved spontaneously.

INITIAL ASSESSMENT

The patient’s vitals, as well as cardiac and lung exams, were within normal limits. Diagnostic tests, including ECG, chest CT, and brain MRI, revealed no abnormalities. During her hospital assessment, she experienced another episode of needle like pain in heart area.

ETIOLOGY

Breathing or changes in posture compress the intercostal nerves, triggering sharp, localized chest pain. However, the pain typically resolves quickly with posture adjustments or deep breathing. This condition is benign and lacks any underlying cardiovascular or respiratory causes.

PRECORDIAL CATCH SYNDROME SYMPTOMS

  • Episodic Nature: Episodic chest pain is the hallmark of Precordial Catch Syndrome, which typically occurs suddenly and intermittently.
  • Sharp or Stabbing Pain: People often describe the pain as a sharp, stabbing sensation in the chest that comes and goes.
  • Localized to the Intercostal Space: The pain commonly affects the intercostal spaces, which are the areas between the ribs. While it often occurs on the left side of the chest, it can also impact other regions.
  • Triggered by Breathing or Posture: Deep breaths, sudden inhalations, or changes in posture often trigger or intensify the pain. These movements put pressure on the intercostal nerves, resulting in sharp discomfort.
  • Duration: While the episodes are usually brief, lasting only a few minutes, they can sometimes be longer. In this patient, the episode lasted an unusually prolonged 90 minutes, which is atypical for precordial chest pain.
  • Resolution with Maneuvers: The pain typically resolves with simple interventions such as lying down, taking deep breaths, or adjusting posture. This helps alleviate pressure on the intercostal nerves.

TREATMENT MODALITIES

precordial chest pain

Simple maneuvers that alleviate pressure on the intercostal nerves often provide relief from precordial chest pain.

These include:

  • Lying Down: Changing posture, mainly lying down, can help reduce the mechanical stress on the chest and the intercostal spaces, providing significant relief.
  • Forced Deep Inspiration: Taking deep breaths or forced inhalations can help stretch the chest wall muscles and intercostal spaces, easing the tension and stopping the precordial catch syndrome chest pain.
  • Changing Breathing Patterns or Posture: Shifting positions or altering the breathing pattern, such as slow, controlled breaths, can also reduce nerve irritation and provide symptom relief.

PROGNOSIS AND FUTURE DIRECTIONS

Precordial Catch Syndrome typically has a favorable prognosis, with most patients experiencing a complete resolution of symptoms over time. The frequency of episodes tends to decrease with age, and the condition often resolves by the mid-20s.

However, further evaluation is necessary to rule out other potential underlying causes in atypical or persistent precordial chest pain cases.