Differential Diagnosis for a 13-year-old Male with Breathlessness and Difficulty Swallowing

Single most likely diagnosis

• Acute Epiglottitis: Given the symptoms of breathlessness, difficulty in swallowing, noisy breathing, and retraction, acute epiglottitis is a strong consideration. It's a medical emergency that can cause significant airway obstruction, especially in children and individuals with compromised immunity or anatomical issues, such as those with mental retardation.

Other Likely diagnoses

• Foreign Body Aspiration: This is a common cause of acute respiratory distress in children, especially those with mental retardation who may have a higher risk of putting objects in their mouths. Symptoms can include sudden onset of breathlessness, coughing, and difficulty swallowing.
• Pneumonia: Although the SpO2 is 97% on room air, pneumonia could still be a consideration, especially if the patient has been experiencing difficulty swallowing, which could lead to aspiration pneumonia. The presence of retraction and efforts in breathing also supports this diagnosis.
• Anaphylaxis: Although less likely given the gradual onset over 3 days, anaphylaxis can cause significant respiratory distress, difficulty swallowing, and can be life-threatening. It's essential to consider this, especially if there's any history of allergies.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

• Airway Obstruction due to a Mass or Tumor: Although rare, any mass or tumor in the throat could cause difficulty swallowing and breathing. Given the patient's symptoms, it's crucial not to miss this potentially life-threatening condition.
• Diphtheria: A bacterial infection that can cause a membrane to form over the tonsils and throat, leading to breathing and swallowing difficulties. It's rare in areas with good vaccination coverage but can be deadly if not treated promptly.
• Retropharyngeal Abscess: An infection in the tissues in the back of the throat, which can cause severe difficulty swallowing and breathing. It requires prompt diagnosis and treatment to prevent airway obstruction.

Rare diagnoses

• Angioedema: A rare condition that can cause swelling of the face, lips, tongue, or larynx, leading to difficulty breathing and swallowing. It can be hereditary or acquired.
• Laryngomalacia: A condition where the tissues of the larynx are soft and floppy, causing partial airway obstruction. It's more common in infants but can be considered in older children with developmental delays.
• Tracheomalacia: A rare condition where the cartilage in the trachea is soft, leading to tracheal collapse and respiratory distress. It can be primary or secondary to other conditions.