Pediatric emergency medicine trisk 0561 0561
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sinusitis, orbital cellulitis, or dental abscess. Often these patients will present with
a history of dental or facial pain, sinus congestion, erythema, or fever. A history
of environmental exposure should lead to the diagnosis of other common causes
of localized swelling including sunburn, frostbite, and plant-induced dermatitis
(poison ivy). Although rarely seen, pit viper envenomation may cause rapid onset
of painful swelling at the site of injury (see Chapter 90 Environmental
Emergencies, Radiological Emergencies, Bites and Stings ). Occasionally, an
infant will present with unexplained, localized swelling of an extremity that has
been present since birth. In this situation, the possibility of an injury secondary to
birth trauma should be explored. Less commonly, congenital lymphedema
(Milroy disease), Turner syndrome (bilateral leg edema), and Noonan syndrome
(pedal edema) should be considered. Meige disease (lymphedema praecox) is a
hereditary disorder that also results in lymphedema, but patients will present later
in childhood or around puberty, usually with swelling of the feet or lower legs.
FIGURE 25.1 Edema in children. GI, gastrointestinal; SIADH, syndrome of inappropriate
secretion of antidiuretic hormone.
