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

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.