Differential Diagnosis for a 16-year-old Male with Respiratory Symptoms
Single Most Likely Diagnosis
- Acute Bronchitis: This is the most likely diagnosis given the patient's symptoms of cough, congestion, chest pain when coughing, and production of phlegm. The presence of these symptoms for 3 weeks, along with clear lung sounds, supports this diagnosis as it often presents with a persistent cough and mucus production without significant findings on lung auscultation.
Other Likely Diagnoses
- Viral Upper Respiratory Tract Infection (URTI): The symptoms of runny nose, cough, and congestion are common in viral URTIs. The left ear popping could be related to Eustachian tube dysfunction often seen in URTIs.
- Sinusitis: Given the symptoms of congestion, runny nose with phlegm, and facial or chest pain that worsens with coughing, sinusitis is a plausible diagnosis. The ear popping could be secondary to sinus pressure.
- Allergic Rhinitis: If the patient has allergies, this could explain the runny nose, congestion, and cough, especially if these symptoms are seasonal or triggered by specific allergens.
Do Not Miss Diagnoses
- Pneumonia: Although the lung sounds are clear, pneumonia should always be considered, especially if the patient's condition worsens or if there are signs of severe illness. It's crucial to monitor for fever, increased shortness of breath, or worsening chest pain.
- Pulmonary Embolism: Though less common in a 16-year-old, any chest pain, especially if it worsens with deep breathing or coughing, necessitates consideration of pulmonary embolism, particularly if there are risk factors such as recent immobilization or family history of clotting disorders.
- Tuberculosis (TB): A chronic cough with phlegm production could be indicative of TB, especially if the patient has been exposed to someone with TB or has risk factors such as immunocompromised status.
Rare Diagnoses
- Cystic Fibrosis: If the patient has a history of recurrent respiratory infections or symptoms suggestive of pancreatic insufficiency, cystic fibrosis could be considered, though it would be unusual for it to first present at 16 years old without prior symptoms.
- Bronchiectasis: This condition involves permanent enlargement of parts of the airways and could present with chronic cough and phlegm production. It's less common and usually has a more significant history of infections or underlying conditions.
- Sarcoidosis: A multi-system disease that can affect the lungs, presenting with cough, chest pain, and shortness of breath. It's rare in adolescents and would typically have additional systemic symptoms.