What is a hematoma?
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
• Intracranial epidural hematoma: a hematoma between the skull and the outside lining of the brain
• Spinal epidural hematoma: a hematoma between spinal vertebrae and the outside lining of the spinal cord
• 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 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 a 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.
WHAT ARE THE CAUSES OF HEMATOMA?
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 painmade 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 pregnantwomen. 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.
HOW IS A HEMATOMA DIAGNOSED?
Examination of a hematoma includes 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 to assess any underlying conditions and evaluate 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 the clinical situation. Some may require no treatment at all while others may be deemed a medical emergency.
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 mediation 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. 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.
Medical care and definitive treatment of a hematoma depends upon its location, what body parts are affected, and what symptoms are present. For example, a small hematoma of the brain may be observed if the patient is fully awake, while another patient with a head injury may require an operation to save brain tissue. The same may be true with a patient with an intra-abdominal hematoma. If the patient is stable, observation may be appropriate, but if shock develops, some surgical intervention may be required.