Q: The left side of my face gets swollen up often. Initially, it starts as an insect bite, itches sometimes at the start of the swelling and then spreads to whole of the left face. There is no pain except a slight heaviness in the left side of the face. It takes around two days for it to disappear, even with antihistamines (citrizine) and serratopeptidase treatment. Also, it keeps reappearing, and now some residual swelling remains even when the symptoms subside. A CT-scan of my head and face shows no other irregularities except the swelling of the facial tissue. What is wrong with me?

A:It seems to be a strange problem, the fact it has been intermittent suggests that it is either allergy or and infection. It is rather difficult to explain as to why there is residual swelling. The fact that there is residual swelling suggest that either venous or lymphatic pressure is cause which may be primary or secondary to the infection or infiltration of some kind or even thrombosis in the draining veins. I suggest that the patient should have the venous duplex scan of the neck veins done and also have MRI of neck done as if there is lymphatic obstruction due to lymphangiitis or lymph node involvement in infection or neoplasm then it may reflect in the MRI of the neck. It is not uncommon to have the thrombosis of the neck vein or the superior vena cava resulting in residual swelling of the face. In this case it is unilateral so it may well be internal jugular or the innominate vein thrombosis. This would be demonstrated by Venous duplex scan. In the end one may have to resort to venous angiography or lymphangiography of the head and neck.