Hematoma – Causes, Symptoms and Treatment
A hematoma is a localized collection of blood outside blood vessels, typically caused by an injury. It often appears as a bruise on the skin.
Things worth knowing about "Hematoma"
A hematoma is a localized collection of blood outside blood vessels, typically caused by an injury. It often appears as a bruise on the skin.
What is a Hematoma?
A hematoma is an abnormal collection of blood that pools outside of blood vessels, usually within body tissue. It occurs when blood vessels are damaged by trauma, surgery, or a medical condition, causing blood to leak into the surrounding tissue or into a defined cavity. Hematomas can form in the skin, muscles, internal organs, or within the skull around the brain.
Causes
The most common causes of hematomas include:
- Blunt force trauma: Bumps, falls, or impacts that damage blood vessels without breaking the skin.
- Surgical procedures: Blood can accumulate in tissue after an operation.
- Clotting disorders: Conditions such as hemophilia or the use of blood-thinning medications (e.g., warfarin, aspirin) significantly increase the risk.
- Spontaneous hematomas: Can occur in patients with vascular diseases, even without an obvious trigger.
Types of Hematomas
Superficial (Subcutaneous) Hematomas
These form just beneath the skin and appear as blue, purple, or yellowish discolorations. They are generally harmless and resolve on their own.
Intramuscular Hematomas
Blood collects within muscle tissue, causing swelling, pressure, and pain. In severe cases, this can lead to compartment syndrome, a serious condition requiring urgent treatment.
Subdural and Epidural Hematomas
Subdural hematomas form between the brain and its protective membranes, often following a head injury. Epidural hematomas occur between the skull and the outer brain membrane and are considered a medical emergency.
Organ Hematomas
Hematomas within internal organs such as the liver, spleen, or kidneys most commonly result from severe trauma and require immediate medical attention.
Symptoms
Symptoms of a hematoma vary depending on its location and size:
- Blue, purple, or yellowish-green skin discoloration
- Swelling and tenderness in the affected area
- Warmth and firmness of the overlying tissue
- In brain hematomas: headache, confusion, nausea, vomiting, or neurological deficits
- In large hematomas: possible drop in blood pressure and signs of shock
Diagnosis
Superficial hematomas are usually diagnosed by clinical examination. For deeper or internal hematomas, the following diagnostic tools are used:
- Ultrasound (Sonography): Useful for imaging soft tissue and organ bleeds.
- Computed Tomography (CT scan): The preferred method for detecting intracranial hematomas.
- Magnetic Resonance Imaging (MRI): Provides detailed imaging and helps determine the age of a hematoma.
- Blood tests: Used to assess clotting function and identify underlying disorders.
Treatment
Conservative Treatment
Most small hematomas resolve on their own within days to weeks. The following measures support recovery:
- RICE method: Rest, Ice, Compression, Elevation -- particularly effective in the acute phase after injury.
- Pain relief with medications such as ibuprofen or paracetamol
- Cooling the area during the first 24 to 48 hours
- Gentle warmth after the acute phase to promote reabsorption of the blood
Surgical Treatment
Large or dangerous hematomas -- especially intracranial or organ hematomas -- may require surgical drainage. Subdural or epidural hematomas are typically treated by neurosurgical procedures such as craniotomy or burr hole drainage.
Treatment of Underlying Conditions
When hematomas result from clotting disorders or medication use, the underlying cause must be addressed -- for example, by adjusting anticoagulant dosages or administering clotting factors.
When to See a Doctor
Seek immediate medical attention if you experience:
- A hematoma following a head injury, especially with loss of consciousness, vomiting, or vision changes
- Severe or worsening pain and swelling
- A hematoma without an identifiable cause
- A hematoma while taking blood-thinning medication
References
- Pschyrembel Clinical Dictionary, 268th Edition, De Gruyter, Berlin 2020.
- Greaves I, Porter K, Garner J: Consensus statement on the early management of crush injury and prevention of crush syndrome. Journal of Trauma, 2003.
- AWMF Guidelines for the Management of Traumatic Brain Injury, AWMF Registration Number 008-001, 2022.
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