Differential Diagnosis
- Single most likely diagnosis
- Acute appendicitis: The patient's symptoms and imaging findings, including a mildly distended, fluid-filled appendix without surrounding inflammatory fat stranding, are consistent with early or developing acute uncomplicated appendicitis.
- Other Likely diagnoses
- Pulmonary infection (e.g., pneumonia): The presence of a 9 mm noncalcified middle lobe nodule with surrounding ground-glass opacity suggests a possible infectious or inflammatory process in the lung.
- Gastroenteritis: The patient's elevated white blood cell count (WBC) and abdominal symptoms could also be indicative of gastroenteritis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendiceal rupture or perforation: Although the imaging findings do not currently show overt signs of perforation, it is essential to monitor the patient closely for any signs of worsening, as a ruptured appendix can lead to severe complications.
- Pulmonary embolism: Although the patient's imaging findings do not specifically suggest a pulmonary embolism, it is crucial to consider this diagnosis, especially if the patient has any underlying risk factors or symptoms such as sudden onset of chest pain or shortness of breath.
- Diverticulitis: Although the imaging findings are more suggestive of appendicitis, diverticulitis is another possible diagnosis that could present with similar symptoms and should be considered, especially if the patient has a history of diverticulitis.
- Rare diagnoses
- Intussusception: A rare condition in which a part of the intestine telescopes into another part, which could cause abdominal symptoms and elevated WBC.
- Yersinia or other atypical appendicitis: Atypical causes of appendicitis, such as Yersinia, can present with similar symptoms and imaging findings.
SOAP Note
S - Subjective: The patient presents with abdominal symptoms and an elevated WBC count. O - Objective: Imaging findings reveal a mildly distended, fluid-filled appendix and a 9 mm noncalcified middle lobe nodule with surrounding ground-glass opacity. A - Assessment: The patient's symptoms and imaging findings are consistent with early or developing acute uncomplicated appendicitis and a possible pulmonary infection. P - Plan: The patient should be closely monitored for any signs of worsening, and further evaluation and treatment should be guided by the patient's clinical course and response to initial management. Consideration should be given to surgical evaluation for possible appendicitis and antibiotic treatment for the pulmonary infection.