Differential Diagnosis for Head Trauma in a 17-Month-Old Child
Single Most Likely Diagnosis
- Basilar Skull Fracture: The presence of dry blood in the right ear canal, combined with the history of head trauma, makes basilar skull fracture a likely diagnosis. The fact that the child had ear tubes and there's blood in the ear canal suggests a possible fracture involving the temporal bone.
Other Likely Diagnoses
- Concussion: Given the mechanism of injury (fall onto cement) and the immediate crying without loss of consciousness, a concussion is a possible diagnosis. The absence of acute intracranial abnormalities on the CT head supports this.
- Sinusitis: The complete opacification of the ethmoid and maxillary sinuses could be indicative of sinusitis, especially in a child with a history of ear tubes, suggesting possible Eustachian tube dysfunction and increased risk of sinus infections.
Do Not Miss Diagnoses
- Intracranial Hemorrhage: Although the CT head shows no acute intracranial abnormality, it's crucial not to miss a potential intracranial hemorrhage, especially if the child's condition changes or if there are any signs of increased intracranial pressure.
- Child Abuse: The history provided does not immediately suggest non-accidental trauma, but given the age of the child and the mechanism of injury, it's essential to consider and investigate the possibility of child abuse, ensuring the child's safety.
- Cerebrospinal Fluid (CSF) Leak: The presence of blood in the ear canal could also indicate a CSF leak, which is a complication of basilar skull fractures. This would require prompt identification and management to prevent infection.
Rare Diagnoses
- Pneumocephalus: Air in the cranial cavity could occur as a result of a skull fracture, especially if there's a communication between the sinuses and the cranial vault. This would be rare but could be considered if there are symptoms suggestive of air in the cranial cavity.
- Otomastoiditis: Infection of the mastoid part of the temporal bone could be a rare complication, especially in a child with a history of ear tubes and now presenting with head trauma and blood in the ear canal.