Severe Swelling: Causes and When to Get Emergency Help

Severe swelling by body part

Severe swelling of the throat

Throat swelling can block the airway within minutes. Causes include:

• Anaphylaxis: a severe allergic reaction to foods, insect stings, latex or medicines, often with hives, wheezing, vomiting and low blood pressure. Treatment is epinephrine, given straight away.
• Angioedema: swelling in deeper skin layers of the lips, tongue, face and throat. It can be allergic, caused by ACE inhibitor blood pressure medicines (even after years of use), or inherited (hereditary angioedema). Non-allergic angioedema does not respond well to epinephrine and needs specific hospital treatment.
• Infections: epiglottitis, a peritonsillar abscess, or Ludwig's angina (a spreading infection under the tongue from a tooth). Expect fever, severe sore throat, muffled voice and drooling.
• Burns, chemical ingestion and injury to the neck.

Sudden throat swelling that leaves you unable to speak properly is always an emergency, even if it starts to improve.

Severe swelling of a joint

In adults

• Injury: sprains and fractures cause swelling within hours. Rapid swelling often means bleeding into the joint.
• Gout and pseudogout: sudden, intensely painful, red, hot swelling, often overnight.
• Septic arthritis: a bacterial infection of the joint, with heat, swelling, severe pain on any movement and usually fever. It can destroy a joint within days and needs urgent treatment.
• Inflammatory arthritis: rheumatoid or psoriatic arthritis cause swelling, often in several joints, with morning stiffness.

What causes severe swelling on wrists in kids

• Injury: buckle (torus) and other wrist fractures are very common in children after falling on an outstretched hand. A swollen, tender wrist after a fall needs an X-ray, even if the child can move it.
• Infection: septic arthritis or bone infection (osteomyelitis) causes swelling, fever and refusal to use the hand.
• Juvenile idiopathic arthritis: swelling and morning stiffness in one or more joints lasting 6 weeks or more, often with little pain.
• Insect bites and allergic reactions: large local swelling, often itchy rather than painful.
• Henoch-Schönlein purpura (IgA vasculitis): joint swelling with a raised purple rash on the legs and buttocks and belly pain.

Severe swelling of a limb

• Deep vein thrombosis: a clot in a deep vein, usually one calf or thigh, causing swelling, warmth, aching and redness. Risk rises after surgery, long travel, pregnancy, cancer and hormonal medicines.
• Cellulitis: a skin infection causing spreading redness, heat, swelling and pain, often with fever.
• Compartment syndrome: pressure builds inside a muscle compartment after a fracture, crush injury or tight cast. Pain is severe and worse when the muscles are stretched. It needs emergency surgery.
• Lymphedema: gradual, persistent swelling when lymph drainage is damaged, often after cancer surgery or radiation.
• Bites and stings: large local reactions can swell an entire limb over 1 to 2 days.

Swelling of both legs or the whole body

Generalized swelling (edema) is usually caused by fluid retention from heart failure, kidney disease such as nephrotic syndrome, liver cirrhosis, low protein levels, pregnancy or medicines such as calcium channel blockers and NSAIDs. See edema. It develops over days to weeks rather than minutes.

How doctors find the cause

The first step for throat or facial swelling is to make sure the airway is safe. Then doctors ask about timing, triggers, injuries, medicines, allergies and other symptoms, and examine the swollen area. Tests can include:

• X-ray for fractures
• Ultrasound for blood clots, abscesses and joint fluid
• Joint aspiration to test fluid for infection or crystals
• Blood tests for infection, inflammation, clotting (D-dimer), kidney and liver function, and complement levels for hereditary angioedema
• Compartment pressure measurement if compartment syndrome is suspected
• CT scan for deep neck infections

Treatment

• Anaphylaxis: intramuscular epinephrine, then emergency care. Everyone who has had anaphylaxis should carry two epinephrine auto-injectors and have an action plan.
• Angioedema: antihistamines and steroids for allergic cases. Stopping ACE inhibitors and specific medicines for hereditary or medicine-related angioedema.
• Infections: antibiotics, and drainage of abscesses or infected joints.
• Blood clots: anticoagulant medicines.
• Fractures: splinting, casting or surgery.
• Compartment syndrome: emergency fasciotomy (surgical release of pressure).
• Fluid retention: treating the heart, kidney or liver problem, often with diuretics.

First aid for swelling from minor injuries

Use rest, ice, compression and elevation: rest the area, apply ice wrapped in a cloth for 15 to 20 minutes every 2 to 3 hours for the first 48 hours, use a firm but not tight bandage, and raise the limb above heart level. Remove rings, watches and bracelets early. If a bandage or cast feels too tight, or fingers or toes become numb, cold or pale, get help right away.

Frequently asked questions

What causes sudden severe swelling of the throat?

The most common causes are anaphylaxis and angioedema, triggered by foods, stings, medicines (especially ACE inhibitors) or inherited conditions. Infections such as epiglottitis or deep neck abscesses also cause throat swelling. Any throat swelling that affects breathing, swallowing or speech is an emergency.

What can cause severe swelling on wrists in kids?

The most common cause is a fracture after a fall, even when the child can move the wrist. Other causes include joint or bone infection, juvenile idiopathic arthritis, insect bites, allergic reactions and IgA vasculitis. A swollen wrist with fever or refusal to use the hand needs urgent assessment.

What causes severe swelling of a wrist joint in adults?

Common causes are sprains and fractures, gout or pseudogout, septic arthritis and inflammatory arthritis such as rheumatoid arthritis. A hot, red, swollen wrist with fever needs same-day care to rule out infection. Swelling after a fall should be X-rayed.

When is swelling an emergency?

Swelling is an emergency when it affects breathing, swallowing or speech, comes with hives, wheezing or fainting, follows an injury with severe pain and numbness, or occurs with sudden breathlessness or chest pain. Call 911 or your local emergency number in these situations.