Differential Diagnosis for a 4-year-old boy with abdominal pain, bilateral pneumonia, and recent ultrasound and flat plate of abdomen results
- Single most likely diagnosis:
- Viral gastroenteritis: The patient's symptoms of abdominal pain, explosive flatus, and passage of formed stool, along with the presence of air-filled bowel loops in the epigastric region and left hemiabdomen, suggest a viral infection of the gastrointestinal tract. The recent history of cough, cold, and conjunctivitis also supports a viral etiology.
- Other Likely diagnoses:
- Mesenteric adenitis: The patient's abdominal pain, particularly in the epigastric and hypogastric areas, could be due to mesenteric adenitis, which is often associated with viral infections.
- Pneumonia-related abdominal pain: The patient's bilateral pneumonia could be causing referred abdominal pain, especially if the pneumonia is severe or involves the lower lobes.
- Constipation: The patient's explosive flatus and passage of formed stool could be indicative of constipation, which is a common cause of abdominal pain in children.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Appendicitis: Although the appendix was not visualized on the ultrasound, appendicitis is a critical diagnosis that must be considered, especially if the patient's abdominal pain is severe or localized to the right lower quadrant.
- Intussusception: This is a life-threatening condition that can cause abdominal pain, vomiting, and bloody stools. Although the ultrasound did not show any evidence of intussusception, it is essential to consider this diagnosis, especially if the patient's symptoms worsen.
- Perforated viscus: The presence of pre-sacral air on the flat plate of abdomen suggests the possibility of a perforated viscus, which is a surgical emergency.
- Rare diagnoses:
- Inflammatory bowel disease (IBD): Although IBD is rare in children, it can cause chronic abdominal pain, diarrhea, and weight loss. The patient's symptoms and ultrasound results do not strongly suggest IBD, but it is essential to consider this diagnosis if the patient's symptoms persist or worsen.
- Henoch-Schönlein purpura (HSP): This is a rare condition that can cause abdominal pain, purpura, and joint pain. Although the patient's symptoms do not strongly suggest HSP, it is essential to consider this diagnosis if the patient's symptoms worsen or if purpura develops.