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, which may suggest a propensity for upper respiratory 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 in the context of head trauma. Repeat imaging or close observation may be necessary.
- Child Abuse: The history provided by the uncle must be scrutinized, and the possibility of non-accidental trauma (child abuse) should be considered, especially if there are inconsistencies in the story or other suspicious injuries.
Rare Diagnoses
- CSF Leak: A basilar skull fracture could potentially lead to a cerebrospinal fluid (CSF) leak, which might not be immediately apparent. The presence of clear fluid in the ear canal (not just blood) could be a sign of this, although it's not mentioned in the scenario provided.
- Pneumocephalus: Air in the cranial cavity, which could occur with a skull fracture, is a rare but potential complication of head trauma. It might not be immediately visible on a CT scan, especially if it's a small amount.