Differential Diagnosis for a 2-year-old with Right Lower Extremity Pain
Single Most Likely Diagnosis
- Toddler's fracture: A common injury in toddlers, typically occurring when a child falls and twists their leg, causing a fracture of the tibia or fibula. The age and presentation make this a highly plausible diagnosis.
Other Likely Diagnoses
- Infection (cellulitis or osteomyelitis): Infections can cause pain and swelling in the affected limb. Given the age of the patient, infections are a common concern and should be considered.
- Trauma (contusion or sprain): Accidental injuries are common in toddlers, and a contusion or sprain could cause significant pain.
- Growing pains: Although more common in the evening and typically bilateral, growing pains could be considered, especially if the pain is intermittent and not associated with other alarming signs.
Do Not Miss Diagnoses
- Septic arthritis: A serious condition that requires prompt treatment. It can present with pain, swelling, and decreased mobility of the affected joint.
- Malignancy (e.g., neuroblastoma or osteosarcoma): Although rare, malignancies can cause bone pain and must be considered to avoid delayed diagnosis.
- Non-accidental trauma (child abuse): It's crucial to consider the possibility of child abuse, especially if the history provided does not match the injury or if there are signs of other injuries.
Rare Diagnoses
- Legg-Calve-Perthes disease: A rare condition characterized by avascular necrosis of the femoral head, more common in children aged 4-8 years but can occur in younger children.
- Juvenile idiopathic arthritis: An autoimmune condition that can cause joint pain and swelling. It's less common in this age group but should be considered if other signs of arthritis are present.
- Osteogenesis imperfecta: A genetic disorder that affects the bones, causing them to be fragile and prone to fractures. It would be considered if there's a history of frequent fractures with minimal trauma.