Differential Diagnosis
The patient's symptoms of congestion, runny nose, green sputum, and maxillary sinus pressure that have been persistent for 7 plus days can be evaluated under the following categories:
- Single Most Likely Diagnosis
- Acute Bacterial Sinusitis: This is the most likely diagnosis given the duration of symptoms (over 7 days) and the presence of green sputum, which suggests a bacterial infection. The maxillary sinus pressure is also consistent with sinusitis.
- Other Likely Diagnoses
- Viral Upper Respiratory Infection (URTI): Although the duration of symptoms is longer than typical for a viral URTI, some viruses can cause prolonged symptoms. The presence of green sputum could be due to a secondary bacterial infection.
- Allergic Rhinitis: This could be a contributing factor, especially if the patient has a history of allergies. However, the green sputum and maxillary sinus pressure might suggest a more infectious process.
- Chronic Sinusitis: If the patient has had recurrent episodes of sinusitis or persistent symptoms, chronic sinusitis could be considered, but the acute presentation suggests a more recent onset.
- Do Not Miss Diagnoses
- Orbital Cellulitis or Abscess: Although rare, these conditions can arise from untreated or severe sinusitis and can lead to serious complications, including vision loss. The presence of facial pain, especially if severe, and signs of orbital involvement (e.g., proptosis, limited eye movement) would necessitate urgent evaluation.
- Cavernous Sinus Thrombosis: This is a rare but potentially life-threatening complication of sinusitis. Symptoms might include severe headache, fever, and signs of increased intracranial pressure, along with cranial nerve deficits.
- Meningitis: In rare cases, sinusitis can lead to meningitis, especially if the infection spreads intracranially. Symptoms such as severe headache, fever, stiff neck, and altered mental status would prompt an urgent evaluation for meningitis.
- Rare Diagnoses
- Fungal Sinusitis: This is more common in immunocompromised patients but can occur in anyone. It might present with similar symptoms to bacterial sinusitis but could have a more insidious onset and might not respond to typical antibiotic treatments.
- Sinusitis due to Unusual Pathogens: In immunocompromised patients or those with specific exposures (e.g., travel history), sinusitis could be caused by less common pathogens, requiring a broader diagnostic approach and potentially different treatment strategies.
- Nasal or Sinus Tumors: Although very rare, tumors in the nasal cavity or sinuses could present with chronic or recurrent sinusitis symptoms. A lack of response to typical treatments or the presence of additional symptoms like nasal obstruction or bleeding might prompt further investigation.