Differential Diagnosis

The patient presents with a neck lump, chest discomfort, ear pain, and other symptoms. Based on the provided information, the following differential diagnoses are considered:

• Single most likely diagnosis
  • Reactive lymphadenopathy: The presence of a soft, irregular, and mobile swelling in the left posterior triangle of the neck, which is non-tender on palpation, suggests a reactive lymphadenopathy. The slightly elevated CRP and GGT levels also support this diagnosis. The patient's history of vaping and occasional alcohol consumption may contribute to the development of reactive lymphadenopathy.
• Other Likely diagnoses
  • Tuberculous lymphadenitis: Although less likely, tuberculous lymphadenitis is a possible diagnosis, given the patient's symptoms of neck lump, chest discomfort, and slightly elevated CRP. However, the absence of fever, night sweats, and weight loss makes this diagnosis less likely.
  • Metastatic lymphadenopathy: The patient's age and history of vaping increase the risk of malignancy. Metastatic lymphadenopathy is a possible diagnosis, although the absence of other symptoms such as weight loss, fatigue, and skin lesions makes it less likely.
  • Thyroiditis: The patient's symptoms of neck lump and throat tightness could be related to thyroiditis. However, the absence of thyroid function tests and specific symptoms such as thyroid tenderness makes this diagnosis less likely.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Lymphoma: Although less likely, lymphoma is a potentially life-threatening diagnosis that should not be missed. The patient's symptoms of neck lump, chest discomfort, and slightly elevated CRP and GGT levels could be related to lymphoma.
  • Metastatic cancer: The patient's history of vaping and occasional alcohol consumption increases the risk of malignancy. Metastatic cancer is a possible diagnosis that should not be missed, given the potential for serious consequences if left untreated.
• Rare diagnoses
  • Sarcoidosis: The patient's symptoms of neck lump, chest discomfort, and slightly elevated CRP and GGT levels could be related to sarcoidosis. However, the absence of other symptoms such as skin lesions, joint pain, and eye symptoms makes this diagnosis less likely.
  • Kikuchi-Fujimoto disease: This rare disease is characterized by lymphadenopathy, fever, and night sweats. Although the patient does not have all the typical symptoms, Kikuchi-Fujimoto disease is a possible diagnosis that should be considered in the differential diagnosis.