A 5 YEAR-OLD BOY WITH ATYPICAL UPPER LIP SWELLING

Abstract

<h3>Introduction</h3> Lip swelling is a common chief complaint in the allergy clinic, but not all swelling is angioedema. Clinicians should keep their differential diagnoses broad when evaluating these patients. This is a case of lymphatic malformation (LM) in a boy with atypical upper lip swelling. <h3>Case Description</h3> A 5-year-old boy with a past medical history of asthma, tree nut allergy, allergic rhinitis, and atopic dermatitis presented for evaluation of persistent upper lip and maxillary gingival swelling. His lip swelling started suddenly and persisted for two years. The family reported intermittent "white fluid" drainage from the affected gingiva. Physical examination showed diffuse upper lip swelling and maxillary gingival swelling. Given his clinical history, his family and pediatrician attributed this swelling to an allergic reaction. He reported no improvement with daily antihistamines, but he did experience transient improvement with oral steroids. Contrast enhanced facial MRI was nonspecific, demonstrating a poorly defined area of mucosal thickening involving the upper lip and anterior maxillary alveolar ridge. He was evaluated by pediatric ENT who referred him to pediatric neurointerventional radiology for suspicion of LM. An ultrasound demonstrated a microcystic LM, notable for tiny anechoic areas without internal flow in the superior lip. The parents are considering definitive diagnosis with a biopsy and treatment options such as sclerotherapy. <h3>Conclusion</h3> LMs can be misdiagnosed as angioedema and should be considered in the differential diagnoses in patients with atypical lip swelling. Contrast enhanced MRI and ultrasound with color Doppler imaging are the recommended imaging modalities for evaluation.