Differential Diagnosis for 11-year-old Girl with Cough, Left Flank Pain, and Ear Pain
- Single most likely diagnosis:
- Pneumonia: This is a common condition in children that can cause cough and flank pain if the pneumonia is located at the base of the lung and is irritating the diaphragm, which shares nerve roots with the flank area. Ear pain could be referred pain or a separate issue like an ear infection, which is also common in children.
- Other Likely diagnoses:
- Urinary Tract Infection (UTI): Could cause flank pain and, if the infection spreads to the kidneys (pyelonephritis), might lead to systemic symptoms including cough if there's an associated pneumonia or if the child has a severe infection.
- Sinusitis: Can cause cough and ear pain due to the connection between the sinuses and the Eustachian tube, which regulates ear pressure. Flank pain might be less directly related but could occur if the child has a severe headache or body aches associated with the sinus infection.
- Costochondritis or musculoskeletal pain: Could explain the flank and chest pain if the cough is severe and persistent, leading to muscle strain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pneumonia with complications (e.g., abscess, empyema): While pneumonia is already considered, its complications can be severe and life-threatening.
- Pyelonephritis with sepsis: A severe UTI that reaches the kidneys can lead to sepsis, a life-threatening condition.
- Pulmonary embolism (very rare in children but possible): Though extremely rare, it's a condition that could present with sudden onset of cough and chest or flank pain and is life-threatening.
- Rare diagnoses:
- Tuberculosis (TB): Could present with chronic cough, flank pain if there's kidney involvement, and potentially ear pain if there's lymph node involvement affecting the ear.
- Sarcoidosis: A rare condition in children that can affect multiple organs, including the lungs, and might present with a variety of symptoms including cough and pain.
- Relapsing polychondritis: An autoimmune disorder that could affect the cartilage of the ears, nose, and trachea, potentially causing ear pain, cough, and other respiratory symptoms.