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Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes. [1] [3] The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs. [1] Often it is associated with hives, which are swelling within the upper skin. [1] [3] Onset is typically over minutes to hours. [1]
The disease mechanism (pathophysiology) of RS3PE remains unknown. One study suggested a possible role for vascular endothelial growth factor. [13] A study using magnetic resonance imaging found that tenosynovitis of the extensors of the hands and feet is the major contributor to edema. [14]
[1] [2] Lower legs and heels may also be involved, however the distal parts of feet and toes are usually spared. Patients may also experience high-graded fever, pitting edema and hypotension. The clinical presentation usually resembles cellulitis, however bilateral involvement is a differentiating feature.
Normal C1 inhibitor level hereditary angioedema is thought to involve various mutations that increased bradykinin activity and cause a decreased threshold for activation of the plasma contact system thus leading to the symptoms of angioedema. [7] Hereditary angioedema with normal C1-inhibitor is a genetically heterogeneous disorder.
Typical areas of swelling include the face, arms, and legs, while internally some individuals have swelling of the tongue and upper airways. [3] In contrast to hereditary angioedema, there tend to be fewer symptoms of the abdomen or gastrointestinal tract, but symptoms of nausea, vomiting, and diarrhea have been seen in acquired angioedema. [3]
As a result, associated symptoms include edema in the lower legs, ascites in the abdomen, and effusions around internal organs. Laboratory tests aimed at assessing liver function diagnose hypoalbuminemia. Once identified, it is a poor prognostic indicator for patients with a variety of different diseases.
The initial step in the clinical work-up should be considering the differential diagnoses of additional common causes of atrophie blanche. Vasculitis, peripheral arterial vascular disease, and lower extremity chronic venous insufficiency are the most frequent conditions to be taken into account during the differential diagnosis process.
Edema primarily affects the extremities, especially the backs of the hands and feet. It is frequently asymmetric and begins distally. [4] It can spread to the forearms and legs, but it can also appear on the face, eyelids, earlobes, and even the scrotum. [5] Edema can be painful. [6] AHEI can sometimes appear without fever or edema but without ...
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