- Hematoma and Types
- Symptoms and Signs
Things to know about hematoma and types
Hematoma is generally defined as a collection of blood outside of blood vessels. Most commonly, hematomas are caused by an injury to the wall of a blood vessel, prompting blood to seep out of the blood vessel into the surrounding tissues. A hematoma can result from an injury to any type of blood vessel (artery, vein, or small capillary). A hematoma usually describes bleeding which has more or less clotted, whereas a hemorrhage signifies active, ongoing bleeding.
Hematoma is a very common problem encountered by many people at some time in their lives. Hematomas can be seen under the skin or nails as purplish bruises of different sizes. Skin bruises can also be called contusions. Hematomas can also happen deep inside the body where they may not be visible. Hematomas may sometimes form a mass or lump that can be felt. Sometimes hematomas are named based on their location. Some examples include:
- Subdural hematoma: a hematoma between the brain tissue and the inside lining of the brain
- Spinal epidural hematoma: a hematoma between spinal vertebrae and the outside lining of the spinal cord
- Intracranial epidural hematoma: a hematoma between the skull and the outside lining of the brain
- Subungual hematoma: a hematoma under the nail
- Intra-abdominal, peritoneal, or retroperitoneal hematoma: a hematoma inside the abdominal cavity
- Ear or aural hematoma: a hematoma between the ear cartilage and overlying skin
- Splenic hematoma: a hematoma within the spleen
- Hepatic hematoma: a hematoma within the liver
Most hematomas resolve spontaneously over time as the blood debris is removed and the blood vessel wall is repaired by the body's repair mechanisms. Other times, surgically removing or evacuating the blood in a hematoma becomes necessary based on its symptoms or location.
What are the causes of hematoma?
The most common cause of a hematoma is injury or trauma to blood vessels. This can happen as a result of any damage to blood vessels that can disrupt the integrity of the blood vessel wall. Even minimal damage to a small blood vessel can result in a hematoma. For example, a hematoma under a nail (subungual hematoma) can simply occur from minor trauma to the nail or from a light stroke against an object.
More severe traumas can cause more major hematomas. Falling from a height or getting into a motor vehicle accident can cause noticeably large bleeding under the skin or inside body cavities (chest or abdomen).
Other types of tissue injury causing a hematoma can result from surgeries of any sort, invasive medical or dental procedures (for example, biopsies, incision and drainage, cardiac catheterization), and injections of medications (for example, insulin, blood thinners, vaccines). Because these procedures damage nearby tissues and blood vessels, often hematomas may form around the site of the procedure.
Occasionally, a hematoma may happen spontaneously without any identifiable cause or recollection of any specific injury or trauma.
Certain blood thinner medications can increase the risk of hematoma formation. People who take medications such as Coumadin (warfarin), Plavix (clopidogrel), aspirin, Persantine (dipyridamole)), or aspirin-containing products (like Alka Seltzer) may develop a hematoma much easier and with less severe injury to their blood vessels than other people. These medications impair the clotting ability of the blood and therefore, minor damage to a blood vessel becomes more difficult to repair, resulting in hematoma formation.
Other common medications and supplements that may increase bleeding tendencies include:
- vitamin E,
- nonsteroidal anti-inflammatory drugs or NSAIDs such as ibuprofen (Motrin, Advil, Aleve),
- garlic supplements, and
- Ginkgo biloba.
In summary, a list of medications causing excess bleeding include:
- warfarin (Coumadin),
- clopidogrel (Plavix),
- aspirin-containing products (Alka Seltzer),
- dipyridamole (Persantine),
- vitamin E,
- NSAIDs, for example, ibuprofen, Motrin, Advil, Aleve,
- garlic supplements, and
- Ginkgo biloba.
There are also certain medical conditions that may pose an additional risk for developing hematomas. Individuals with the following conditions are potentially at a higher risk for hematomas:
What are the symptoms and signs of a hematoma?
Symptoms of a hematoma generally depend on its size and location. Pain, swelling, redness, and disfiguring bruises are common symptoms of hematoma in general. Some symptoms specific to the location of a hematoma are:
- Subdural hematoma symptoms: headache, neurologic problems (weakness on one side, difficulty speaking, falling), confusion, seizures
- Epidural hematoma symptoms: back pain, weakness, loss of bowel or bladder control
- Subungual hematoma symptoms: nail pain, nail weakness, nail loss, disfiguring nail
- Splenic, hepatic, or peritoneal hematoma symptoms: abdominal pain, flank pain
Sometimes there are not any symptoms at all associated with even a very large hematoma. For example, if bleeding happens to be inside the abdominal cavity, it can expand into a very large size before it causes any symptoms. This can happen because the hematoma can spread in relatively free space without pressing on any organs to cause pain or other symptoms.
On the other hand, a small hematoma under the nail can present with a lot of pain because the blood expands into a very tight space under the nail bed and causes inflammation and irritation of the nearby nail and skin, resulting in pain and swelling.
Depending on the location of the hematoma, a mass or lump can sometimes be felt.
When should I seek medical care for a hematoma?
Medical attention may be sought for a hematoma if its symptoms are severe or its size continues to expand. For example, hematoma in the brain (subdural) or epidural hematoma generally require prompt medical and surgical attention, especially if they are associated with neurologic problems.
Doctors who typically care for patients with hematoma are emergency room physicians, urgent care physicians, surgeons, neurosurgeons, and internal medicine doctors.
How is a hematoma diagnosed?
Examination of a hematoma includes a physical inspection along with a comprehensive medical history. In general, there are no special blood tests for the evaluation of a hematoma. However, depending on the situation tests including
- complete blood count (CBC),
- coagulation panel,
- chemistry and metabolic panel, and
- liver tests may be useful in evaluating a person with a hematoma and assessing any underlying conditions, and evaluating whether these are responsible for the hematoma formation.
Imaging studies are often needed to diagnose hematomas inside the body.
- Computerized tomography (CT) of the head can reliably diagnose subdural hematoma.
- CT of the abdomen is a good test if a hematoma in the abdominal cavity (intra-abdominal, hepatic, splenic, retroperitoneal, peritoneal) is suspected.
- Magnetic resonance imaging (MRI) is more reliable in detecting epidural hematomas than a CT scan.
What is the treatment for a hematoma?
- Treatment of hematoma depends on the location, symptoms, and clinical situation.
- Some may require no treatment at all while others may be deemed a medical emergency.
Can I care for a hematoma myself?
Simple therapies at home may be utilized in treating superficial (under the skin) hematomas. Most injuries and bruises can be treated with resting, icing, compression, and elevating the area. This is remembered by the acronym RICE. These measures usually help to reduce inflammation and diminish its symptoms.
- Ice (Apply the ice or cold pack for 20 minutes at a time, 4 to 8 times a day.)
- Compress (Compression can be achieved by using elastic bandages.)
- Elevate (Elevation of the injured area above the level of the heart is recommended.)
When using ice packs, apply the ice or cold pack for 20 minutes at a time, 4 to 8 times a day. Compression can be achieved by using elastic bandages, and elevation of the injured area above the level of the heart is recommended.
What is the medical treatment for a hematoma?
For certain small and symptom-free hematomas, no medical treatment may be necessary. On the other hand, symptomatic hematomas or those located in certain locations sometimes require medical or surgical treatment.
Even though no specific medication is available for the treatment of hematomas, management of any related symptoms can be achieved by medications. For example, pain from a hematoma can be treated with pain medications such as acetaminophen (Tylenol).
Surgical drainage is a common method of treatment for certain hematomas. The presence of symptoms and location of the hematoma generally dictate what type of procedure is needed and how urgently it needs to be done. For example, a subdural hematoma resulting in symptoms such as headache, weakness, or confusion may require urgent drainage by a neurosurgeon. Conversely, if a subdural hematoma is thought to be symptom-free and chronic, it may be left alone and monitored occasionally by imaging studies (CT scan).
- Furthermore, a subungual hematoma with severe discomfort can be drained through the nail to allow the blood to drain from the space between the nail and the underlying tissue. Large subungual hematomas that are left in place can sometimes compromise the nail and result in the nail dying and falling out. Draining such hematomas can save the overlying nail.
If any underlying cause or contributing factor exists that predisposes to bleeding, its correction or treatment may also be a necessary step in treating hematomas. For example, if a person with a hematoma is on a blood thinner medication for another condition, the treating doctor may opt to discontinue or even reverse the blood thinner, depending on the individual situation.
Should I follow-up with my doctor?
Location, symptoms, and size of a hematoma are the typical factors that determine its proper follow-up. For example a small, symptom-free (asymptomatic) subdural hematoma may only require repeat CT scans of the head every few months for follow-up.
On the other hand, a large leg hematoma that had been opened and drained may be observed within a few days to ensure expected improvement.
Can a hematoma be prevented?
Prevention of all hematomas is not entirely possible. However, the prevention of hematomas in certain contexts deserves special attention.
In people, especially the elderly, who take blood thinners or anti-platelet medications (aspirin or clopidogrel), falls are a common cause of trauma and hematoma formation. Falls can cause hematomas in the legs, chest, or brain, and may, at times, result in significant illness or death. Therefore, measures to prevent falls in this population potentially lower the frequency of hematomas as well.
Children are also at risk to develop hematomas frequently due to falls and minor injuries. In particular, younger children are more prone to bumping their heads, causing a small egg-shaped swelling in the area of injury. Therefore, child-proofing the home and furniture may help in decreasing hematomas in children.
Hematoma that results from trauma due to heavy physical work or contact sports is less preventable unless such activities are stopped or modified to reduce the risk of trauma and injury.
Tova Alladice, M.D.
American Board of Physical Medicine & Rehabilitation