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The typical cause of chest pain in a 21-year-old after coughing is often attributed to spontaneous pneumothorax. This condition occurs when air leaks into the space between the lung and chest wall, which can happen spontaneously without any apparent reason, particularly in younger individuals and those who are tall and thin.

Coughing creates a sudden increase in intrathoracic pressure, which could potentially cause or exacerbate a pneumothorax. The chest pain associated with this condition is usually sharp and can be worsened by breathing or movement, aligning with the presentation of the patient. Given the age of the individual and the nature of the symptom following a coughing episode, spontaneous pneumothorax is the most plausible explanation.

While conditions like acute myocardial infarction, pneumonia, and pulmonary embolism can cause chest pain, they are less likely in a healthy 21-year-old, especially without other risk factors or symptoms associated with those conditions.