Differential Diagnosis for a 5-month-old Boy with Wheezing
- Single most likely diagnosis
- E) Bronchiolitis: This is the most likely diagnosis given the age of the patient, the preceding symptoms of coryza (common cold), and the presence of wheezing, tachypnea, chest retractions, and the radiographic findings of bilateral air trapping and peribronchial thickening. Bronchiolitis is a common lower respiratory tract infection in infants, typically caused by the respiratory syncytial virus (RSV).
- Other Likely diagnoses
- C) Asthma: Although less likely in a first episode, especially at this age, asthma could be considered, particularly if there's a family history or if the child has had previous episodes of wheezing. However, the acute onset following coryza and the specific radiographic findings make bronchiolitis more likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- B) Aspiration of a foreign body: This is a critical diagnosis not to miss, as it can lead to severe respiratory distress and requires immediate intervention. The presentation can sometimes mimic bronchiolitis or asthma, but the history might reveal an episode of choking or coughing before the onset of symptoms.
- D) Bacterial tracheitis: Although less common, bacterial tracheitis is a serious condition that can present with similar symptoms, including wheezing and respiratory distress. It requires prompt diagnosis and antibiotic treatment.
- Rare diagnoses
- A) Anaphylactic reaction: While anaphylaxis can cause respiratory symptoms, it is typically associated with other systemic symptoms such as rash, hypotension, and gastrointestinal symptoms, which are not mentioned in the scenario.
- Other rare conditions could include congenital anomalies of the airways or immune deficiencies, but these would be less likely given the acute presentation following a viral syndrome.