Differential Diagnosis for a 65-year-old Male with Nasal Congestion and Sinus Pressure
- Single most likely diagnosis:
- Acute Bacterial Sinusitis: This is the most likely diagnosis given the patient's symptoms of nasal congestion, sinus pressure, postnasal drainage, and low-grade temperatures that have persisted despite over-the-counter medications. The duration of symptoms (2 weeks) also supports this diagnosis, as acute bacterial sinusitis typically lasts more than 7-10 days.
- Other Likely diagnoses:
- Acute Viral Rhinosinusitis: Although the patient's symptoms have lasted for 2 weeks, it's possible that the initial infection was viral, and the patient is experiencing a prolonged recovery or a secondary bacterial infection.
- Allergic Rhinitis: The patient's symptoms of nasal congestion, postnasal drainage, and sinus pressure could be indicative of allergic rhinitis, especially if the patient has a history of allergies.
- Chronic Sinusitis: Given the patient's age and the fact that he has been experiencing increasing maxillary sinus pressure, it's possible that he has an underlying chronic sinusitis that has been exacerbated by a recent infection.
- Do Not Miss diagnoses:
- Orbital Cellulitis or Abscess: Although rare, these conditions can occur as a complication of sinusitis and can lead to serious consequences, including vision loss and intracranial infection, if not promptly treated.
- Cavernous Sinus Thrombosis: This is a rare but potentially life-threatening complication of sinusitis that requires prompt diagnosis and treatment.
- Malignancy (e.g., Sinus Cancer): Although unlikely, it's essential to consider malignancy in the differential diagnosis, especially in older adults, as sinus cancer can present with similar symptoms.
- Rare diagnoses:
- Fungal Sinusitis: This is a rare condition that typically affects immunocompromised individuals, but it can occur in immunocompetent individuals as well.
- Granulomatosis with Polyangiitis (formerly known as Wegener's Granulomatosis): This is a rare autoimmune disorder that can cause sinusitis, among other symptoms.
- Sarcoidosis: This is a rare condition that can cause sinusitis, among other symptoms, and is often diagnosed after other conditions have been ruled out.