Differential Diagnosis

The patient presents with frontal and maxillary sinus pain, "stuffy nose", sore throat, and nocturnal cough. Based on the symptoms and physical exam findings, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Chronic Sinusitis: The patient's symptoms of frontal and maxillary sinus pain, "stuffy nose", and sore throat, along with the CT sinuses showing maxillary sinus opacification, support this diagnosis. The duration of symptoms (3-4 weeks) also aligns with chronic sinusitis.
• Other Likely Diagnoses
  • Acute Exacerbation of Chronic Sinusitis: Although the patient's symptoms have been present for 3-4 weeks, it is possible that an acute exacerbation of chronic sinusitis is occurring, especially if the patient has a history of chronic sinusitis.
  • Allergic Rhinitis: The patient's symptoms of "stuffy nose" and sore throat could be related to allergic rhinitis, especially if the patient has a history of allergies.
  • Upper Respiratory Tract Infection: Although the patient's symptoms have been present for 3-4 weeks, an upper respiratory tract infection (e.g., viral or bacterial) could still be a possible diagnosis.
• Do Not Miss Diagnoses
  • Wegener's Granulomatosis: This is a rare autoimmune disorder that can cause sinusitis, but it can also be life-threatening if not diagnosed and treated promptly.
  • Nasal Tumor or Cancer: Although rare, a nasal tumor or cancer could cause similar symptoms and should be considered, especially if the patient has a history of smoking or other risk factors.
  • Invasive Fungal Sinusitis: This is a rare but potentially life-threatening condition that can occur in immunocompromised patients or those with severe underlying medical conditions.
• Rare Diagnoses
  • Sarcoidosis: This is a rare autoimmune disorder that can cause sinusitis, but it is often associated with other systemic symptoms.
  • Eosinophilic Granuloma with Polyangiitis (Churg-Strauss Syndrome): This is a rare autoimmune disorder that can cause sinusitis, but it is often associated with other systemic symptoms, such as asthma and eosinophilia.

Justification for each diagnosis is based on the patient's symptoms, physical exam findings, and diagnostic test results. The single most likely diagnosis is chronic sinusitis, given the duration of symptoms and the CT sinuses showing maxillary sinus opacification. Other likely diagnoses, such as acute exacerbation of chronic sinusitis, allergic rhinitis, and upper respiratory tract infection, are considered based on the patient's symptoms and physical exam findings. Do not miss diagnoses, such as Wegener's granulomatosis, nasal tumor or cancer, and invasive fungal sinusitis, are considered due to their potential for serious consequences if not diagnosed and treated promptly. Rare diagnoses, such as sarcoidosis and eosinophilic granuloma with polyangiitis (Churg-Strauss syndrome), are considered based on their potential to cause similar symptoms, although they are less likely.