Differential Diagnosis for a 16-year-old Male with Respiratory Symptoms
Single Most Likely Diagnosis
- Viral Upper Respiratory Tract Infection (URTI): This is the most likely diagnosis given the symptoms of cough, congestion, runny nose with phlegm, and chest pain, which are typical of a viral infection. The presence of clear lung sounds also supports this diagnosis, as it suggests that the infection is primarily limited to the upper respiratory tract.
Other Likely Diagnoses
- Acute Bronchitis: Although the lung sounds are clear, the cough and chest pain could also be indicative of acute bronchitis, especially if the patient has been producing phlegm. This condition often follows a viral upper respiratory infection.
- Sinusitis: The symptoms of congestion, runny nose, and phlegm production, along with the ear popping (which could indicate Eustachian tube dysfunction), might suggest sinusitis, particularly if the symptoms have persisted for three weeks.
- Allergic Rhinitis: If the patient has allergies, the symptoms of runny nose, congestion, and cough could be due to allergic rhinitis, especially if these symptoms recur at the same time every year or are triggered by specific allergens.
Do Not Miss Diagnoses
- Pneumonia: Although the lung sounds are clear, pneumonia must be considered, especially if the patient's condition worsens or if there are signs of severe infection such as high fever, difficulty breathing, or chest pain that worsens with deep breathing.
- Pulmonary Embolism: Although less common in a 16-year-old, pulmonary embolism can present with chest pain and cough. It's a critical diagnosis to consider, especially if there's a history of recent immobilization, family history of clotting disorders, or other risk factors.
- Tuberculosis (TB): TB can present with chronic cough, chest pain, and systemic symptoms. It's essential to consider TB, especially if the patient has been exposed to someone with TB or has risk factors such as immunocompromised status.
Rare Diagnoses
- Sarcoidosis: This is a rare condition that can cause respiratory symptoms, including cough and chest pain, due to granulomatous inflammation. It would be considered if other diagnoses are ruled out and there are systemic symptoms or findings suggestive of sarcoidosis.
- Cystic Fibrosis: If the patient has a history of recurrent respiratory infections or other symptoms suggestive of cystic fibrosis (such as malabsorption), this diagnosis might be considered, although it would typically be diagnosed earlier in life.
- Interstitial Lung Disease: Various forms of interstitial lung disease can present with respiratory symptoms. These are rare in adolescents and would be considered if other diagnoses are excluded and there are specific findings on imaging or pulmonary function tests.