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Causes of Facial Swelling in Pediatric Patients: Correlation of Clinical and Radiologic Findings¹

¹ From the Departments of Radiology (G.K., Y.S.), Otolaryngology (R.J.H.S., N.M.B.), and Ophthalmology (J.N.), University of Iowa College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242. Recipient of a Certificate of Merit award for an education exhibit at the 2003 RSNA Annual Meeting. Received March 15, 2005; revision requested April 4 and received May 25; accepted June 6. All authors have no financial relationships to disclose. Address correspondence to G.K. (e-mail: geetika-khanna{at}uiowa.edu).

Facial swelling is a common clinical problem in pediatric patients. The causes of swelling are diverse, and knowledge of the typical clinical and imaging manifestations and the most common sites of occurrence of these conditions is needed to formulate a differential diagnosis. The general clinical manifestations may be classified into the following four groups: (a) acute swelling with inflammation, (b) nonprogressive swelling, (c) slowly progressive swelling, and (d) rapidly progressive swelling. Conditions that may account for acute swelling accompanied by inflammation include lymphadenitis, sinusitis, odontogenic infection, and abscess. Contrast-enhanced computed tomography is the modality of choice for detection of abscesses requiring surgical drainage. Nonprogressive midfacial swelling is suggestive of a congenital anomaly (eg, a cephalocele, nasal glioma, or nasal dermoid or epidermoid cyst). Slowly progressive swelling may indicate the presence of a neurofibroma, hemangioma, lymphangioma, vascular malformation, or pseudocyst, or of fibrous dysplasia. The differential diagnosis for rapidly progressive facial swelling in association with cranial nerve deficits should include rhabdomyosarcoma, Langerhans cell histiocytosis, Ewing sarcoma, osteogenic sarcoma, and metastatic neuroblastoma.

© RSNA, 2006

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