Differential Diagnosis for 48-year-old Female with Sinus Pressure and Congestion
- Single most likely diagnosis:
- Acute Bacterial Sinusitis: The patient's symptoms of worsening sinus pressure and congestion, tenderness and pressure in her cheeks, postnasal drainage, and productive cough with green phlegm are consistent with acute bacterial sinusitis. The lack of improvement with over-the-counter (OTC) decongestants and the presence of purulent discharge (green phlegm) further support this diagnosis.
- Other Likely diagnoses:
- Acute Viral Sinusitis: Although the patient denies recent sinus infections, viral sinusitis could still be a consideration, especially given the recent worsening of symptoms. However, the productive cough with green phlegm and lack of response to OTC decongestants lean more towards a bacterial cause.
- Allergic Rhinitis: The patient's symptoms of sinus pressure, congestion, and postnasal drainage could also be consistent with allergic rhinitis, especially if she has a history of allergies. However, the presence of green phlegm and tenderness in the cheeks might suggest a more infectious process.
- Vasomotor Rhinitis: This condition, often related to stress, hormonal changes, or environmental factors, could contribute to the patient's nasal congestion and sinus pressure. The recent death of her father could be a stressor contributing to vasomotor rhinitis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Sinusitis Complications (e.g., Orbital Cellulitis, Cavernous Sinus Thrombosis): Although less likely, complications of sinusitis can be life-threatening and require immediate medical attention. Symptoms such as severe headache, fever, proptosis, or decreased vision would necessitate further investigation.
- Malignancy (e.g., Sinus Cancer): Though rare, sinus cancer could present with similar symptoms of sinus pressure and congestion. A history of smoking increases the risk, making it essential not to miss this diagnosis.
- Rare diagnoses:
- Fungal Sinusitis: This condition is more common in immunocompromised patients but could be considered in a patient with persistent or worsening symptoms despite appropriate treatment for bacterial sinusitis.
- Granulomatosis with Polyangiitis (GPA): Formerly known as Wegener's granulomatosis, GPA is a rare autoimmune disorder that can affect the sinuses and respiratory tract, presenting with symptoms similar to those of the patient. However, it would typically be associated with other systemic symptoms and findings.