Angioedema

Diagnosis: Angioedema

Extensive swelling of the lower lip secondary to massive edema.

Clinical Presentation

Extensive swelling of the lower lip secondary to massive edema.

Clinical History

Submitted by Alaa Saad. Originally posted September 23, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Cellulitis • Contact dermatitis • Superior vena cava syndrome • Hypothyroidism (myxedema) • Lymphedema • Dermatomyositis (periorbital edema)

Key Learnings

• Deep dermal/subcutaneous swelling — can be life-threatening when involving airway • Two main mechanisms: mast cell-mediated (histaminergic) vs. bradykinin-mediated • ACE inhibitor-induced angioedema: bradykinin-mediated — does NOT respond to antihistamines or epinephrine • Hereditary angioedema (HAE): C1-INH deficiency — no urticaria, recurrent episodes • ACE inhibitor angioedema can occur years after starting medication • HAE: C4 is the best screening test (low even between attacks)

Tags: angioedema, alaa saad