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, as appendicitis can progress rapidly.
- Pulmonary embolism: Although the patient's imaging findings do not suggest a pulmonary embolism, it is a potentially life-threatening condition that should be considered, especially if the patient has 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 portion of the intestine telescopes into another portion, which could cause abdominal symptoms and elevated WBC.
- Yersinia or other atypical appendicitis: Atypical causes of appendicitis, such as Yersinia, could present with similar symptoms and imaging findings.
SOAP Note
S - The patient presents with abdominal symptoms and an elevated WBC count of 17.1, with imaging findings concerning for early or developing acute uncomplicated appendicitis and a possible infectious or inflammatory process in the lung. O - Imaging findings include a mildly distended, fluid-filled appendix without surrounding inflammatory fat stranding, and a 9 mm noncalcified middle lobe nodule with surrounding ground-glass opacity. A - The patient's symptoms and imaging findings are consistent with acute appendicitis and a possible pulmonary infection. P - The patient should be monitored closely for signs of appendiceal rupture or perforation and should be treated with antibiotics and possibly surgery, depending on the progression of symptoms and imaging findings. Further evaluation and management of the pulmonary nodule may also be necessary.