Differential Diagnosis for a 7-year-old boy with fever, drooling, dysphagia, and painful neck movements
- Single most likely diagnosis:
- Retropharyngeal abscess: This condition is highly suspected given the history of a recent foreign body (fish bone) impaction in the throat, which could have led to a deep neck infection. Symptoms such as drooling, dysphagia, and painful neck movements are classic for a retropharyngeal abscess, especially in a child.
- Other Likely diagnoses:
- Peritonsillar abscess: Although less likely than retropharyngeal abscess given the specific symptoms, peritonsillar abscess could present with similar symptoms including fever, dysphagia, and neck pain. The recent history of a throat foreign body could potentially be a predisposing factor.
- Cervical lymphadenitis: This condition, which is an infection of the lymph nodes in the neck, could explain the fever, cervical lymphadenopathy, and painful neck movements. It might be a complication of the initial throat infection or a separate infectious process.
- Do Not Miss diagnoses:
- Epiglottitis: Although less common in the era of widespread vaccination against Haemophilus influenzae type b (Hib), epiglottitis is a life-threatening condition that requires immediate recognition and intervention. Symptoms can include dysphagia, drooling, and significant respiratory distress.
- Airway foreign body: Given the recent history of a fish bone impaction, there's a possibility, although less likely given the time frame, that another foreign body could be causing the current symptoms, especially if the initial removal was incomplete or if a new object was ingested.
- Rare diagnoses:
- Lemierre's syndrome: This is a rare condition characterized by a bacterial infection of the jugular vein, often following a throat infection. It could potentially explain some of the symptoms but is less likely given the clinical presentation.
- Actinomycosis: A rare chronic bacterial infection that can affect the face and neck, potentially causing abscesses and lymphadenopathy. It's an unlikely diagnosis given the acute presentation but could be considered in the differential for persistent or unusual infections.