Intended for healthcare professionals

Endgames Case Review

New onset unilateral arm swelling in a child with periorbital oedema

BMJ 2020; 368 doi: (Published 02 January 2020) Cite this as: BMJ 2020;368:l5988
  1. Yasmine F Z Cherfi, Foundation Year 1 doctor1,
  2. Krisztina B Szanto, Foundation Year 1 doctor2,
  3. Janette Cansick, consultant paediatrician3
  1. 1St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  3. 3Medway Maritime Hospital, Gillingham, UK
  1. Correspondence to Y Cherfi yasmine.cherfi{at}

An 8 year old girl was referred to the paediatric assessment unit with four weeks of puffy eyes following a suspected viral upper respiratory tract infection. Her facial swelling had exacerbated in the two weeks before this presentation, and her mother had noticed that her trousers no longer fitted because of abdominal and thigh swelling. The child was eating normally with normal bowel movements, and was afebrile.

On examination, generalised oedema was noted, including periorbital and facial swelling, and a distended, non-tender abdomen. On chest auscultation, there were some fine basal crepitations bilaterally. The child’s left forearm was notably more swollen …

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