TABLE 25.1 CAUSES OF EDEMA Decreased oncotic pressure Protein loss Protein-losing enteropathy Nephrotic syndrome Reduced albumin synthesis Liver disease Malnutrition Increased hydrostatic pressure Increased blood volume from water and sodium retention Congestive heart failure Primary renal sodium retention Acute glomerulonephritis Henoch–Schönlein purpura Nephrotic syndrome Renal failure Premenstrual edema or edema of pregnancy Venous obstruction Constrictive pericarditis Acute pulmonary edema Portal hypertension Budd–Chiari syndrome Local venous obstruction Thrombophlebitis/deep venous thrombosis Increased capillary permeability Allergic reaction Hereditary angioedema Inflammatory reactions Burns Cellulitis Sepsis Pit viper envenomation Vasculitis Lymphatic dysfunction/other Hypothyroidism (myxedema) Lymphedema Milroy disease Meige disease (lymphedema praecox) Turner syndrome Noonan syndrome Epstein–Barr virus infectious mononucleosis (upper eyelid edema) TABLE 25.2 COMMON CAUSES OF EDEMA Localized Allergic reaction Cellulitis Trauma Generalized Nephrotic syndrome Allergic reaction TABLE 25.3 LIFE-THREATENING CAUSES OF EDEMA Localized Allergic reaction with airway involvement Medication induced angioedema Hereditary angioedema Cellulitis (with bacteremia) Pit viper envenomation Superior vena cava syndrome Venous thrombosis Cerebral edema Reexpansion pulmonary edema Generalized Cardiac disease Congestive heart failure Pericardial effusion Hepatic failure Renal disease Nephrosis Nephritis Sepsis Localized bilateral upper eyelid edema (Hoagland sign) may be found in up to 50% of patients with Epstein–Barr virus (EBV) infectious mononucleosis It is not associated with any significant discomfort, is seen only for the first few days of the illness, and is very specific for EBV so that it may be used to trigger further laboratory evaluation to confirm the diagnosis When a child presents with severe or recurrent facial edema, especially if there is a family history of similar symptoms, the diagnosis of hereditary angioedema (see Chapter 85 Allergic Emergencies ) should be considered When a patient with localized edema of the head or neck presents for care, it is crucial that the physician evaluate the child carefully for concurrent airway involvement Facial edema may also be caused by oral, dental, or sinus infections, including acute