Doctor's Notes on Hematoma
A hematoma is a collection of blood outside of a blood vessel. Hematomas can occur anywhere in the body and are often described by their location, such as subdural hematoma, epidural hematoma, intra-abdominal hematoma, or hepatic hematoma. Hematomas can be caused by bleeding due to any cause including trauma or injury, defects in blood vessels, or problems with blood clotting.
Symptoms and signs of hematomas may include a bluish discoloration of the skin or lump beneath the skin. When the hematoma is present inside the skull cavity, associated symptoms and signs can include headache, confusion, seizures, loss of bladder or bowel control, or other neurologic symptoms. Signs and symptoms of a hematoma are very specific to the exact location within the body.
Head and physical trauma injuries may cause life-threatening bleeding and hematomas. Seek medical care if an individual experiences the following symptoms after a head or other traumatic physical injury:
- Severe headache associated with nausea, vomiting, and confusion
- Loss of consciousness
- Uneven pupils
- The inability to move a leg or an arm
- Excessive sleepiness
- Hearing loss
- Difficulty swallowing
Hematomas may occur commonly and some have little importance while others are life-threatening. Many times it is a matter of location and situation that makes the hematoma a critical condition instead of an inconvenience.
Hematomas cause irritation and inflammation. Symptoms depend upon their location and whether the size of the hematoma or the associated swelling and inflammation cause nearby structures to be affected. The common symptoms of inflammation include:
- pain, and
Hematomas tend to resolve over time.
- The initial firm texture of the blood clot gradually becomes more spongy and soft as the clot is broken down by the body.
- The shape changes as the fluid drains away and the hematoma flattens.
- The color changes from that of a purplish-blue bruise to yellows and browns as the blood clot degrades and the hematoma resolves.
Hematomas are usually caused by trauma, whether it is the result of a car accident, a minor bump, a cough, or an unknown event. The blood within blood vessels is continually flowing and therefore does not clot or coagulate. When blood leaves the circulatory system and becomes stagnant, there is almost immediate clotting. The greater the amount of bleeding that occurs, the larger the hematoma.
Anticoagulant medications, including aspirin, warfarin (Coumadin), clopidogrel (Plavix) and dipyridamole (Persantine) may be associated with blood clots. Diseases or infections may occur that decrease the number of platelets in the bloodstream or their ability to function. The platelets are the cells that help initiate blood clotting. If platelets are inhibited, bleeding can continue and hematomas can develop and expand. Examples of bacterial infections, autoimmune diseases, and other situations that may lead to hematomas include:
- Finger infections
- Ankylosing spondylitis
- Hematomas of the ear may occur if an injury causes bleeding to the cartilage structure of the ear. A common complication of ear hematomas is cauliflower ear.
- Septal hematoma may occur due to nose injuries. A septal hematoma may form associated with a broken nose, and if not recognized and removed, the cartilage can break down and cause a perforation of the septum.
- Internal bleeding into the abdomen may be life-threatening depending upon the cause and the situation and lead to irritation of the lining of the abdomen.
- Hematomas may occur in solid organs like the liver, spleen, and kidney or they may occur within the walls of the small intestine or colon. Hematomas may also form within the lining of the abdomen or behind in the space where the kidneys are located.
- Orthopedic injuries or broken bones may cause hematomas. Bone marrow is where much of the body's blood production occurs, and a fracture may cause significant blood loss.
- Compartment syndrome is an uncommon complication of bleeding and hematoma due to injury. This is an orthopedic emergency as it requires surgery to correct. Symptoms of compartment syndrome include intense pain made worse with movement of the fingers or toes and numbness and tingling of the extremity with decreased pulses in the hand, leg, or foot.
- Pregnancy is associated with subchorionic hemorrhage about 25% of the time. It is the most common abnormality seen by sonographic analysis in pregnant women. Most small to moderate hematomas regress and do not worsen the patient's prognosis. Blood clots and/or bleeding in the third trimester may be a sign of problems such as placenta previa or placental abruption and is considered a medical emergency.
Strains happen when you injure a muscle or tendon -- the fibrous tissue that attaches muscle to bone. Sprains occur when you hurt a ligament, which connects the end of one bone to another. For both injuries, the answer is often RICE: rest, ice, compression, and elevation.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.