In short. History, examination, measurement and imaging, and what each can and cannot show: how swelling that will not settle is sorted into groups.
Key points
- It exists to sort swelling into one of a few groups, because each is treated differently: fluid that has collected, which is drained; an infection, which is treated; a clot, which is an emergency; a general medical cause, which belongs to a physician; and the great majority, which is ordinary swelling that is slow.
An assessment for swelling that will not settle is mostly a conversation and an examination, and the tests that follow are chosen to answer specific questions rather than to look for everything at once.
History
The first part is what was done, when, and to which areas, together with how the swelling has behaved since: whether it is improving, whether it fluctuates through the day, whether it is one side or both, and what makes it better or worse. Your medicines are reviewed, along with previous clots, previous surgery in the same area, and any long period of reduced movement since the operation. General health matters too, because heart, kidney and thyroid problems produce swelling.
Examination
The area is looked at and felt. Softness, whether a dent stays after pressing, warmth, tenderness, redness, the condition of the skin, and whether the swelling is spread through the area or confined to one place are read directly. The same points are examined on the other side for comparison, because a difference between two limbs is more informative than a number on its own, and that is what a later measurement is judged against.
What the assessment is for
It exists to sort swelling into one of a few groups, because each is treated differently: fluid that has collected, which is drained; an infection, which is treated; a clot, which is an emergency; a general medical cause, which belongs to a physician; and the great majority, which is ordinary swelling that is slow.
Measurement and imaging
Limb circumference measured at fixed points, at the same time of day, is the plainest way to show whether swelling is changing, and photographs taken the same way do the same for the face and the trunk. An ultrasound scan is the usual first imaging test: it can show fluid that has collected under the skin, and it can show a clot in the deep veins of a limb. It cannot show everything: a scan that is clear at one point does not always end the question, and it does not explain swelling caused by a general medical problem.
Blood tests
Markers of inflammation and infection, a blood count, thyroid function, kidney and liver function, and the protein level in the blood are the usual ones. A test that is not needed is not ordered simply because swelling is present, and a normal result is still useful: it removes a cause from the list and lets the plan move back to time and review.
Seek emergency care now if
- One limb is swollen, warm and tender, or you are breathless or have chest pain with it.
- Your lips, tongue or throat are swelling, or breathing is difficult.
- There is spreading redness, heat, fever or discharge, or a tense painful swelling — seek care the same day.
Bring the dates of the procedure, a list of your medicines, and dated photographs taken in the same light. The single most useful thing you can say is whether the swelling is getting better, worse, or neither.
Frequently asked questions
What happens at an assessment for swelling that will not settle?
A history of what was done, when and how the swelling has behaved since, a review of your medicines and general health, and an examination of the area compared with the other side. Measurement, photographs, an ultrasound scan and blood tests follow only where they answer a specific question, and the assessment ends in a plan with a review date.
What can an ultrasound scan show about swelling?
It can show fluid that has collected under the skin, and it can show a clot in the deep veins of a limb. Those are the two questions it answers best. It cannot show everything: a scan that is clear at one point does not always end the question, and a scan of a limb does not explain swelling caused by a general medical problem.
Do I need blood tests for swelling after a procedure?
Only where a specific question needs answering. Markers of infection and inflammation, a blood count, thyroid function, kidney and liver function and the protein level in the blood are the usual ones. A test that is not needed is not ordered simply because swelling is present, and a normal result is still useful because it removes a cause from the list.
Risks & Limitations
- Swelling settles on a different clock in each area: weeks for the face, months for body contouring, and limbs slowest of all.
- It settles unevenly, and one side commonly resolves before the other; firmness and lumpiness under the skin outlast the visible swelling.
- Fluid that has collected behaves differently from ordinary oedema: it is drained rather than waited on, and it can re-form after drainage.
- Compression, elevation and gentle movement improve comfort and speed, and none of them resolves a collection or repairs lymph drainage that has been affected.
- An operation is the last step rather than the first: it is planned once the swelling has resolved, and it begins a second recovery with its own swelling.
- An area can look over-corrected while it is swollen, and it is judged later rather than in the first weeks.
When to Seek Care
- One leg or arm swollen, warm and tender, especially after being still — seek emergency care now.
- Breathlessness or chest pain together with swelling in a limb — seek emergency care now.
- Swelling of the lips, tongue or throat, or difficulty breathing — seek emergency care now.
- Swelling with spreading redness, heat, fever or discharge — seek care the same day.
- A swelling that is tense, hard and painful, or growing quickly — seek care the same day.
- Both legs swollen, with weight gain and breathlessness — seek urgent care now.
References & Further Reading
- World Health Organization (WHO) — patient safety and venous thromboembolism information
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — guidance on venous thromboembolism and on chronic oedema
- Cochrane Library — systematic reviews of compression and of seroma management
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.