Differentiate Between Angioedema From Cellulitis in Pediatric Patients With Periorbital Swelling on Point‐of‐Care Ultrasound

• Published in: Journal of clinical ultrasound Vol. 53; no. 4; pp. 748 - 752
• Main Authors: Tay, Ee Tein, Tsung, James W., Lin, Yue Jay, Sanders, Jennifer E.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.05.2025; Wiley Subscription Services, Inc
• Subjects: Adolescent; Allergies; Angioedema; Angioedema - diagnostic imaging; Cellulitis; Cellulitis - diagnostic imaging; Child; Child, Preschool; Diagnosis; Diagnosis, Differential; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Health services; Humans; Infant; Insect bites; Insects; Male; Medical imaging; Patients; Pediatrics; periorbital edema; POCUS; Point-of-Care Systems; Prospective Studies; Soft tissues; Swelling; Ultrasonic imaging; Ultrasonography - methods; Ultrasound; Young Adult; angioedema; POCUS; periorbital edema
• DOI: 10.1002/jcu.23941
• ISSN: 0091-2751; 1097-0096

ABSTRACT Purpose This study evaluated the use of point‐of‐care (POCUS) to differentiate between angioedema and cellulitis in pediatric patients who presented to the emergency department (ED) with periorbital swelling from suspected insect bites. Methods Subanalysis of patients under 21 years old with periorbital swelling from suspected insect bites was performed in patients presenting to the ED. Participating physicians received hands‐on soft tissue ultrasound training prior to study enrollment. Pre‐ and post‐POCUS diagnoses and findings, disposition, ED discharge diagnosis, additional imaging studies, and treatment medications were recorded. Patients received telephone follow‐up 1 week after the visit. Results Twenty‐three subjects were enrolled. Twenty (86.9%) cases had a pre‐POCUS diagnosis of allergic skin reaction, one (4.3%) had cellulitis, and two (8.7%) were undetermined. After POCUS, providers changed diagnoses and treatment management on five (21.7%) patients. Ultrasound features of linear bands were identified in 22 ultrasound images suggesting angioedema. No patients received further imaging or were admitted for hospitalization. Conclusions POCUS may serve as an adjunct tool in differentiating between cellulitis and angioedema in patients with periorbital swelling from local allergic skin reactions from insect bites and decreasing unnecessary imaging studies and hospital admissions. Linear bands of edema on point‐of‐care ultrasound in patients with periorbital swelling from insect bites and local angioedema.