Hematoma - Types, Causes, Symptoms, Treatment, and Complications

Introduction

In hematoma, the bleeding has more or less clotted, whereas a hemorrhage signifies active bleeding. Hematoma is quite common and affects most people at least once in their lives. It is generally seen under the skin or nail beds as discolored bruises of all sizes. Hematomas may also develop deep inside the body. It may result in the formation of a mass or lump.

What Is a Hematoma?

Hematoma is a pooling of blood outside the blood vessels (artery, vein, or small capillary); resulting from an injury or otherwise. An injury to the blood vessel walls leads to a leak or collapse, allowing blood to pool into the surrounding tissue.

What Are the Types of Hematoma?

The type of hematoma depends on its location in the body. The location may also help determine how dangerous it is.

• Ear Hematoma (Aural Hematoma)- It is a common injury in athletes who regularly sustain blows to the head.

• Subungual Hematoma- Appears under the nail.

• Scalp Hematoma- This appears as an elevated bump on the head. The damage is mostly within the external skin and muscle and does not extend to the brain.

• Septal Hematoma- This appears as a result of a broken nose.

• Subcutaneous Hematoma- This appears just under the skin, typically in the shallow veins.

• Retroperitoneal Hematoma- Occurs inside the abdominal cavity but does not affect any organs.

• Splenic Hematoma- Occurs in the spleen.

• Hepatic Hematoma- Occurs in the liver.

• Spinal Epidural Hematoma- Occurs between the lining of the spinal cord and the vertebrae.

• Intracranial Epidural Hematoma- Occurs between the skull plate and the lining on the outside of the brain.

• Subdural Hematoma- Occurs somewhere between the integral brain tissue and the internal epithelial lining of the brain.

What Are the Causes of Hematoma?

Injuries and trauma are the main causes. A hematoma forms when damage happens to the large blood vessels underneath the skin. The skin is intact and does not allow the blood to flow out; hence it begins to accumulate in the area. This causes tissue swelling. Occasionally, a hematoma may produce spontaneously without any recollection of any specific injury or trauma.

People who use medications such as Warfarin and Aspirin (blood thinners) may develop a hematoma much easier and even with a minor injury to their blood vessels than other people. These medications affect the clotting ability of the blood, and therefore, a slight injury becomes more difficult to repair, resulting in hematoma formation.

Medications that can cause excess bleeding include:

• Warfarin.

• Clopidogrel.

• Aspirin.

• Aspirin-containing products.

• Vitamin E.

• NSAIDs, for example, Ibuprofen and Advil.

• Garlic supplements.

• Ginkgo biloba.

Certain long-standing medical conditions have been shown to increase the risk of developing hematomas. Individuals with the following conditions are at a higher risk for hematomas:

• Chronic (long-standing) liver disease.

• Excessive alcohol intake.

• Bleeding disorders (such as hemophilia and Von Willebrand disease),

• Blood cancers.

• Low platelet count.

What Are the Symptoms and Signs of a Hematoma?

General symptoms include- pain, swelling, redness, and disfiguring bruises. Listed below are some symptoms which are specific to the location of a hematoma:

• Subdural Hematomas- Symptoms constitute headache, neurologic problems (weakness on one side, difficulty speaking), confusion, and seizures.

• Epidural Hematomas - Symptoms constitute back pain, weakness, and loss of bowel or bladder control.

• Subungual Hematomas- Symptoms constitute a weakness in nails, nail loss, and disfiguring nails.

• Splenic, Hepatic, or Peritoneal Hematoma Symptoms- Pain in the specific organ region.

There could be no symptoms associated with even a very large hematoma because the hematoma can spread easily in free space without stressing any organs to cause pain or other symptoms. Contrarily, a small hematoma under the nail can present with a lot of pain because of the tight space under the nail bed and can cause inflammation and redness, resulting in pain and swelling.

What Is the Difference Between Bruise and Hematoma?

The discoloration and pain in the affected area can confuse people between hematomas and bruises. A bruise is seen on the top layer of the skin as a purple, blue, dark spot when blood leaks from smaller blood vessels (capillaries). It lightens and then gradually fades away as it heals. Bruises generally are not serious damage but require medication to prevent infection.

In contrast, a hematoma is a result of fluid leakage from a larger blood vessel. The discoloration is seen underneath the affected skin and gets raised, inflamed, and red, and later turns dark blue or black. Severe traumas cause hematomas that may require medical treatment.

People suffering from anemia or are on blood thinners are more prone to bruising.

Depending upon the severity and the cause, a hematoma can take about one to four weeks to heal.

How Is a Hematoma Diagnosed?

Diagnosis of a hematoma includes a physical inspection along with a thorough medical history. Generally, depending on the type of injury, tests including complete blood count and liver tests and imaging such as X-rays for broken bones and ultrasounds to measure the hematoma are useful. If there is a head injury, the doctor will assess the symptoms, check for active bleeding, and order a CT scan or MRI for imaging and future treatment plan.

How Are Hematomas Treated?

1. Most hematomas clear up over time by the body's repair mechanism, by dissolving the collected blood and repairing the broken blood vessel.

2. To manage minor hematoma seen under the surface of the skin, nail, or other soft tissue, restrict the injured area and cover it with an ice pack wrapped in a towel.

It is advised to wrap or splint the area around the hematoma to let the blood vessel heals and not reopen. Doctors may recommend some pain killers.

1. Sometimes, a hematoma may require drainage. If the accumulated blood is generating pressure on the spinal cord, brain, or any other organs, doctors will suggest draining a hematoma and also preventing infection.

2. In rare cases, the hematoma may not dissolve on its own, and the damaged blood vessel continues to leak. A doctor will have to remove it completely.

What Are the Complications Associated With Hematoma?

• A long-standing, undissolved hematoma can cause complications.

• A hematoma formed in the brain is difficult to discover. It may show symptoms such as a recurrent headache, light-headedness, or speech difficulty.

• Anyone who has suffered an injury to the head or a severe injury anywhere in the body should visit a hospital and get a specific test done.

Conclusion:

Hematomas can appear frightening, but proper management and treatment can help dissolve the damage. Conservative treatments can help with minor hematomas seen in the ear or nail.

People who have sustained a blow to the head, been in an accident, or have a hematoma with raised body temperature should see a doctor. With a prompt diagnosis and the proper treatment, most hematomas resolve without complications.