Differential Diagnosis for 17-Month-Old with Head Trauma and Sinus Drainage
- Single Most Likely Diagnosis
- Basilar skull fracture with cerebrospinal fluid (CSF) leak: The presence of dry blood in the ear canal and the history of head trauma suggest a possible basilar skull fracture. The complete opacification of the ethmoid and maxillary sinuses could be related to the trauma or a pre-existing condition, but the key finding is the potential for a CSF leak, which would explain the sinus drainage and is a common complication of basilar skull fractures.
- Other Likely Diagnoses
- Acute sinusitis: The complete opacification of the ethmoid and maxillary sinuses is consistent with acute sinusitis, which could be exacerbated by the head trauma or the presence of ear tubes. The sinus congestion and drainage support this diagnosis.
- Traumatic otitis media: The dry blood in the ear canal and the history of head trauma suggest possible traumatic otitis media, especially given the child's history of ear tubes.
- Do Not Miss Diagnoses
- Meningitis: Although the CT head shows no acute intracranial abnormality, meningitis is a potentially life-threatening condition that can occur after a basilar skull fracture or trauma. The presence of CSF leak or sinus drainage increases the risk of meningitis.
- Intracranial hemorrhage: Despite the initial CT head showing no acute intracranial abnormality, it is crucial to monitor for potential delayed intracranial hemorrhage, especially in the context of head trauma.
- Rare Diagnoses
- Arachnoid cyst or other congenital anomalies: Although less likely, the presence of sinus drainage and the history of head trauma could potentially be related to an underlying congenital anomaly, such as an arachnoid cyst, which could be exacerbated by the trauma.
- Nasal foreign body: In a child of this age, it is possible that the sinus drainage and congestion could be caused by a nasal foreign body, which might have been inserted before or after the head trauma.