Differential Diagnosis for 17-Month-Old with Head Injury
- Single Most Likely Diagnosis
- Basilar skull fracture: The presence of blood in the right ear canal after a head injury is highly suggestive of a basilar skull fracture. The fact that the CT head shows no acute intracranial abnormalities does not rule out this diagnosis, as basilar skull fractures can be subtle and may not always be visible on initial CT scans.
- Other Likely Diagnoses
- Otitic hemorrhage: Given the patient has tubes (tympanostomy tubes) and presented with blood in the ear canal, otitic hemorrhage is a possible diagnosis. This could be related to the trauma or an underlying infection.
- Middle ear trauma: The presence of blood in the ear canal could also indicate trauma to the middle ear, which might not be immediately apparent on a CT scan.
- Do Not Miss Diagnoses
- Intracranial hemorrhage (e.g., epidural, subdural, subarachnoid hemorrhage): Although the CT head shows no acute intracranial abnormalities, it is crucial to consider the possibility of an intracranial hemorrhage that might not be immediately visible or could develop later. Repeat imaging or close observation might be necessary.
- Cerebral edema: This could be a delayed complication of the head injury and is critical to monitor for, especially in pediatric patients.
- Rare Diagnoses
- CSF otorrhea: This is a rare condition where cerebrospinal fluid leaks into the ear canal, which could be a complication of a basilar skull fracture. It's essential to consider this diagnosis if the patient presents with persistent clear discharge from the ear.
- Perilymphatic fistula: Although rare, this condition involves an abnormal connection between the inner and middle ear, which could be caused by trauma. It might present with hearing loss, vertigo, or ear fullness.