Differential Diagnosis for a 2-year-old with PNA 3 weeks ago, now with SOB, Cough, and Retractions
- Single most likely diagnosis
- Post-infectious bronchiolitis obliterans: This condition can occur after a severe respiratory infection, such as pneumonia, and is characterized by chronic respiratory symptoms like cough, shortness of breath, and retractions.
- Other Likely diagnoses
- Reactive airway disease (asthma): A common condition in children that can be triggered by a respiratory infection, leading to symptoms like cough, wheezing, and shortness of breath.
- Pulmonary tuberculosis: Although less common, TB can present with chronic cough, shortness of breath, and retractions, especially if the child was exposed to an infected individual.
- Bronchiectasis: A condition characterized by permanent dilation of the airways, which can occur after a severe respiratory infection, leading to chronic cough, shortness of breath, and retractions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Foreign body aspiration: A life-threatening condition that can occur if the child inhales an object, leading to sudden onset of respiratory symptoms like cough, shortness of breath, and retractions.
- Congenital heart disease: Certain heart defects can present with respiratory symptoms like shortness of breath and retractions, especially if the child has a history of pneumonia.
- Pneumothorax: A potentially life-threatening condition that can occur if air leaks into the space between the lung and chest wall, leading to sudden onset of shortness of breath and retractions.
- Rare diagnoses
- Cystic fibrosis: A genetic disorder that affects the respiratory and digestive systems, leading to chronic respiratory symptoms like cough, shortness of breath, and retractions.
- Primary ciliary dyskinesia: A rare genetic disorder that affects the movement of cilia in the airways, leading to chronic respiratory symptoms like cough, shortness of breath, and retractions.
- Interstitial lung disease: A group of rare disorders that affect the lung tissue, leading to chronic respiratory symptoms like cough, shortness of breath, and retractions.
Workup
The workup for this patient should include:
- Chest X-ray to evaluate for signs of pneumonia, bronchiectasis, or other lung abnormalities
- Pulmonary function tests (PFTs) to assess lung function and diagnose conditions like asthma or bronchiolitis obliterans
- Sweat test to diagnose cystic fibrosis
- Tuberculin skin test (TST) or interferon-gamma release assay (IGRA) to diagnose tuberculosis
- Echocardiogram to evaluate for congenital heart disease
- Flexible bronchoscopy to evaluate for foreign body aspiration or other airway abnormalities
- High-resolution computed tomography (HRCT) scan to evaluate for interstitial lung disease or other lung abnormalities.