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Hematoma and Bruise - Causes, Symptoms, Diagnosis, and Treatment

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Hematomas and bruises may seem similar and have similar causes, but they are not the same. This article goes through everything in detail.

Medically reviewed by

Dr. Muhammad Zohaib Siddiq

Published At October 10, 2022
Reviewed AtMarch 7, 2023

What Is Hematoma?

Hematomas are more extensive bleeding involving larger blood vessels. The seeping blood in a hematoma will pool and clot or create blood clumps. This might result in a firm but tender mass.

Hematomas can form deep within the body, such as in a muscle or in or near an internal organ. They can also develop beneath the skin, on the scalp, nose, ears, or beneath a nail. When the hematoma is close to the skin's surface, it may look like a painful red, black, or blue lump. However, the skin will ultimately turn a yellow or brown tint as it degrades.

Hematomas, unlike bruises, can be fatal. If they grow large enough, they may induce a reduction in blood pressure. They can also cause shock, a potentially fatal illness that occurs when organs in the body do not receive enough blood or oxygen. In addition, extremely big hematomas can cause neighboring organs to move and disrupt their function. Hematomas in the brain and skull are the most serious and life-threatening. This is because blood can become trapped within the head and impose pressure on the brain. Depending on the size and location of the hematoma, the healing period might range from weeks to months.

What Is Bruise?

A bruise is a skin mark formed by minute quantities of blood seeping from broken small blood vessels, such as capillaries. Bruises are also known as ecchymosis or contusions, and those that develop under the surface of the skin are generally highly noticeable. Ecchymosis is a huge bruise that is more than 1 centimeter in diameter. Within five to ten days, the initial black and blue skin discoloration will fade to a yellow, green, or light brown tint. Although minor swelling may be evident, bruises are flat. Therefore, they might be sensitive to touch. Bruises can also develop in deeper tissues, such as muscles and bones. Despite not being able to see the injury site, patients will feel pain and tenderness there. Bruises usually disappear on their own within a week or two.

What Are the Causes of Hematoma and Bruise?

Injuries and trauma most commonly cause hematomas. Any damage to the blood vessel walls may result in blood leaking. As the blood departs, the blood artery pools, resulting in a hematoma. Serious injuries do not always cause hematomas. Hematomas can also be induced by the following factors:

  • Aneurysm (an abnormal bulge or ballooning in the wall of a blood vessel).

  • Several drugs.

  • Viral infections such as rubella, mumps, chickenpox, HIV (human immunodeficiency virus), or hepatitis C.

  • Fractures and other orthopedic injuries.

  • Surgery.

  • Spontaneous bleeding.

  • Bleeding condition.

  • Cancers of the blood.

  • Liver disease.

Everyone bruises sometimes, but older people bruise more quickly because their skin naturally thins with age. Bruises are commonly caused by unintentional traumas such as bumps and falls. Some medical conditions might also make individuals more prone to bruising. A few things might increase a person's risk of bruising. Risk factors for acquiring bruising include.

  • Accidents or bumps.

  • Microscopic tears in the blood vessels beneath the skin in athletes.

  • Bleeding disorders.

  • Aging causes thinner skin.

  • A disease of the liver.

  • Cancer.

  • Deficiency of vitamin C, vitamin D, or vitamin K.

  • Family members that bruise easily.

  • Low platelet count in the blood.

What Are the Signs and Symptoms of Hematoma And Bruise?

Bruises and certain hematomas may appear similar. However, a hematoma might present with various symptoms depending on the location. Hematoma symptoms might be as simple as bruise symptoms, or they can be fatal. Bruises appear quickly after an injury occurs, and the symptoms of bruises mainly include.

  • A dark blue or purple skin patch occurs shortly after an injury.

  • Tenderness in the afflicted region or around it.

  • Minimal swelling.

Hematomas have more severe symptoms than bruises. It may emerge soon following the injury or take many days. Hematoma symptoms and indicators include:

In severe hematoma cases,

  • Confusion.

  • Paralysis (muscle function is lost completely or partially).

  • Slurred speech.

  • Consciousness loss.

  • Seizure (an unexpected and uncontrollable electrical disruption in the brain).

How to Diagnose Hematoma and Bruise?

  • X-Ray: After analyzing the signs and symptoms, most people can self-diagnose a light bruise. However, in case of an enormous bruise and serious injuries, the doctor may request an X-ray of the affected region to confirm no broken bones.

  • Blood Test: If patients experience frequent bruising, the physician may recommend a blood test to rule out a bleeding issue.

  • History and Physical Examination: Bruises are clinically diagnosed through history and physical examination based on the skin's distinctive darkened, non-blanching look. During the physical examination and history, doctors may frequently discover hematomas in the tissues beneath the skin. A hematoma can be identified by swelling or discomfort in a specific region.

  • Imaging Studies: Deeper-seated hematomas and organs, such as the brain or spleen, may require imaging studies to detect radiologic imaging. Imaging tests like computed tomography (CT) scan or magnetic resonance imaging (MRI) may be necessary in the case of an internal hematoma, including one in the skull or brain.

What Are the Treatments for Hematoma and Bruise?

After an injury, treatment should begin as soon as possible for both hematoma and bruise.

  • Rest, ice, compression, and elevation (RICE) are the first-line treatments.

  • In case of pain in the wounded region, over-the-counter medication such as Tylenol or Advil can be used to treat it.

  • Hematomas may not require treatment, and the body will eventually resorb the blood collection biologically.

  • Cold compression can be used as initial therapy for a superficial hematoma. After the bleeding (hemorrhaging) has ceased, further treatment may include warm compresses to assist in reabsorbing the blood in the tissues.

  • Severe hematomas, particularly those involving organs, may necessitate surgical draining to alleviate pressure on the affected tissues. After the blood has been physiologically resorbed, superficial hematomas under the skin may occasionally leave a fluid-filled sac, known as a seroma. Seromas may also necessitate a draining technique, either with a needle and syringe or by surgery.

  • Bruises merely necessitate the avoidance of further harm and the care of the affected skin. Use topical antibiotics and a bandage if there are related skin tears.

  • It is recommended to rest and avoid intense exercise for bruises and hematomas until the swelling goes down.

Conclusion

Bruises are caused by damage to smaller blood vessels, whereas an injury to bigger blood vessels causes hematomas. While bruises are rarely dangerous, hematomas can be fatal, particularly those in the skull or brain. Both bruises and hematomas are caused by bleeding and can result from traumas, bleeding disorders, or other illnesses. A bruise is caused by little blood vessels in the skin, muscle, or bone.

A hematoma is a blood clot that can form close to the surface, such as after a surgical incision. But it can also develop within the skull or deep into the body. A hematoma is much more severe than a bruise. Ice the region, elevate the body part, relax, and take Acetaminophen as first aid for a bruise or a small, apparent hematoma. Medical attention should be sought if patients experience neurological symptoms, acute pain, or swelling.

Frequently Asked Questions

1.

Are Hematomas Bad Than Bruises?

A bruise or contusion on the skin appears following a trauma like a blow to the body. It occurs due to the disruption of small veins and blood vessels beneath the skin. On the other hand, blood pooling outside the blood vessel is called a hematoma. A hematoma is a kind of bad bruise. A hematoma can be worse than a bruise since it is an indicator of an injury more profound in the skin. Some hematomas can even pose a threat to life.

2.

Do Hematoma Bruises Fade Away?

More severe hematomas and bruising can persist for a month or longer. Mild hematoma and contusions can resolve in about five days. A change in color and gradual shrinking can be observed during the healing of large hematomas. If not treated appropriately, there can be permanent tissue damage. Signs of a healing hematoma include a change in the color of the skin over the hematoma from bluish to brown and then yellow as the blood gets dissolved and absorbed.

3.

What Does Hematoma Bruising Resemble?

The pooling of blood outside the blood vessel is called a hematoma.  A hematoma is a bad bruise. In a hematoma, the leaking blood will accumulate (pool) and clot or result in blood clumps. This can form a hard and tender mass. The hematoma near the skin surface can appear like a painful red, blue, or black lump. As it disintegrates, the skin will gradually become yellow or brown.

4.

Is Hematoma Serious?

A hematoma may resemble a bruise, but the damage caused by a hematoma involves large blood vessels. It can result in swelling, discoloration, and warmth and might require medical intervention. Though many hematomas do not cause harm, some might indicate a serious problem. One must be worried if the hematoma symptoms are severe or if it progresses to expand over a few days. Large hematomas can cause a drop in the blood pressure.

5.

Can a Hematoma Heal on Its Own?

A majority of the hematomas will heal on their own without the need for any medical treatment. Mild hematoma and contusions can resolve in about five days. More severe hematomas and bruising can persist for a month or longer. The healing process can be fastened by immobilizing or providing rest to the affected region, applying ice packs, compressing the affected region using an elastic bandage, and keeping the area elevated above the level of the heart.

6.

How does a Physician remove a Hematoma?

A hematoma is gently cleared with the help of suction and irrigation, wherein the hematoma is washed away using a fluid. The surgical site is then reclosed. Hematomas are removed by experts like surgeons, neurosurgeons, internal medicine doctors, emergency room physicians, or urgent care physicians. Surgery is indicated in cases where the hematomas exert pressure on the brain, spinal cord, or other organs or where there is a risk of infection.

7.

Can a Hematoma Be Permanent?

A majority of the hematomas will heal on their own without the need for any medical treatment. Mild hematoma and contusions can resolve in about five days. More severe hematomas and bruising can persist for a month or longer. Usually, hematomas get reabsorbed into the body. However, the healing can be influenced by the hematoma's cause, size, and location. If not treated appropriately, there can be permanent tissue damage.

8.

Does a Hematoma Have the Potential to Turn Into a Cancerous Condition?

A hematoma is usually benign (non-cancerous) and initially in liquid form. At this stage, it spreads among the tissues, including the sac between tissues, where it coagulates and solidifies before it gets reabsorbed into the blood vessels. Some hematomas can increase in size at one point but resolve spontaneously. One must be worried if the hematoma symptoms are severe or if it progresses to expand over a few days.

9.

Do All Hematomas Need to Be Treated by Surgery?

Surgery is indicated in cases where the hematomas exert pressure on the brain, spinal cord, or other organs or where there is a risk of infection. The type of hematoma depends on where it occurs in the body. Similarly, not all hematomas inside the skull require surgery.  A majority of the hematomas will heal on their own without the need for any medical treatment.

10.

Can Ice Packs Be Used on Hematomas?

The healing of hematomas can be fastened using the RICE method. This involves immobilizing or providing rest to the affected region, applying ice packs, compressing the affected region using an elastic bandage, and keeping the area elevated above the heart level. A cold or ice pack should be placed on the affected region for about 10 to 20 minutes. The ideal time to place an ice pack would be within the first six hours following an injury. The cold temperature from the ice pack enables the blood in the affected region to flow more slowly and minimizes the amount of blood that oozes out of the blood vessels.

11.

What Is the Most Serious Hematoma?

One must be worried if the hematoma symptoms are severe or if it progresses to expand over a few days. Hematomas in the brain and skull can pose a threat to life and can be dangerous. Acute types of subdural hematomas are the most dangerous. Intracerebral hematomas and epidural hematomas can also pose a threat. Hematomas inside the skull are the most serious since blood pooling can elevate the pressure and affect the brain's functioning.

12.

Can Hematomas Be Left Untreated?

A majority of the hematomas will heal on their own without the need for any medical treatment. Mild hematoma and contusions can resolve in about five days. More severe hematomas and bruising can persist for a month or longer. If not treated appropriately, there can be permanent tissue damage. One must approach a physician if the hematoma symptoms are severe or if it progresses to expand over a few days.

13.

How Can Hematomas Be Prevented?

One can prevent hematoma by following safety protocols like wearing protective gear when participating in contact sports or other blunt-force trauma activities. In addition, maintaining blood pressure, avoiding the intake of certain medications that can increase the risk of bleeding, and visiting the physician if one experiences an injury that causes skin breakage can help prevent hematomas.
Dr. Muhammad Zohaib Siddiq
Dr. Muhammad Zohaib Siddiq

Cardiology

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