Diagnostic Dilemma

URTI with wheeze


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Question
A 2 years old child presented with cold and cough (more at night) for 5 days and breathlessness for 1 day. There is no fever. Mother has recurrent sinusitis and is allergic to dust. There is no contact with TB. On examination, the child has bilateral wheeze. She has a pinched nose and is a mouth breather and has similar complaints once every month for past 6 months.

What is the diagnosis?
Expert Opinion :
This child has presented with symptoms of cold initially. Cold or runny nose occurs with rhinitis, nasopharyngitis or sinusitis. Since the child’s symptoms were more at night, it suggests a post nasal drip. Sinusitis is more commonly associated with a post nasal drip due to draining of the mucus on lying down. The child is also a mouth breather and has a pinched nose. Thus, adenoids also seem to be hypertrophied. However, the child has a wheeze, has recurrent symptoms and maternal history of allergy. Thus one is very tempted to diagnose asthma in this child. However 20% of wheezy bronchitis is due to sinusitis and irritation due to post nasal drip. Thus, in this child, sinusitis is a possibility apart from asthma. Her X-Ray of paranasal sinuses showed opacification of maxillary sinuses and she had tonsilloadenoidal hypertrophy. Thus, this child has sinusitis. Treatment of sinusitis led to relief of her symptoms.
Answer Discussion :
R
Ramon vilalta casas
bubble
Allergic rhinitis asthma
4 months ago
R
Ramon vilalta casas
bubble
Allergic rhinitis
4 months ago

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