Hematoma is generally characterized by a swelling that is formed by the accumulation of blood under the tissues. This blood is generally leaked from its surrounding vessels such as any vein, artery or capillary due to damaged vessel lining.

Blood leakage leading to hematoma formation is caused as a result of direct or indirect trauma or injury to the soft tissues, but it should be noted that there is a clear difference between hematoma and hemorrhage, i.e. hematoma is the result of slow accumulation of blood under the tissues; whereas hemorrhage refers to massive bleeding and active blood loss to the exterior of the tissues.

What Are the Types of Hematoma?

In most cases, hematomas are named based on the site and location of the blood accumulation. Some of the common types of hematoma include:

• Subdural hematoma - Subdural hematoma is found in between the brain lining that protects the brain and surrounding brain tissues.
• Spinal epidural hematoma – Spinal epidural hematoma is an accumulation of blood in between the spinal lining that protects the spinal cord and tissues of spinal vertebrae.
• Intracranial epidural hematoma – Intracranial epidural hematoma is blood accumulation in between the brain lining and skull.
• Subungual hematoma – Subungual hematoma is collection of blood leaked from vessels under nail tissue.
• Retroperitoneal hematoma - Retroperitoneal hematoma is hematoma inside the peritoneal or abdominal cavity.
• Aural hematoma - Aural hematoma is also known as ear hematoma, in which there is an accumulation of blood in between ear lining and ear cartilage.
• Hepatic hematoma – Hepatic hematoma is accumulation of blood clots under hepatic tissues (liver tissues).
• Splenic hematoma - Hematoma of spleen is termed as splenic hematoma.

What Are the Symptoms of Hematoma?

Some of the characteristic symptoms of hematoma are given below, it must be noted that the symptoms of hematoma may vary according to location, size and severity of hematoma:

• Inflammation of the involved organ and the surrounding tissues
• Redness on the superficial layer
• Pain on the affected site
• Initially the blood clot or hematoma appears to be firm; as soon as the fluid drains from the site, the clot loses its contour
• The color changes are observed in the hematoma that initially occurs as purple-blue hue, which later turned into brown patch
• Most of the times the surrounding organs also show bruising, for instance, hematoma formed in forehead also shows bruising under the eyes
• Some of the intracranial hematoma may produce neurological symptoms such as lightheadedness, dizziness, faintness, etc.
• Nausea and vomiting may appear along with all the symptoms

When to See a Doctor

The location of trauma or injury is very important in the evaluation of hematoma. In any injury, if the patient is aware of his condition but the trauma is minor, the consultation is not required and the hematoma will resolve on its own.

While in some cases of hematoma (depending on the location, especially hematoma of brain); the risk of serious complications is fairly high, such as serious neurological complications due to application of direct clot pressing over the brain. Patient must consult with the healthcare practitioner in case vomiting appears (especially in the setting of intracranial or spinal hematoma).

What Are the Causes of Hematoma?

• Hematoma generally results after an injury or trauma to the body. This trauma may include any accident, gunshot wounds, fall from a height etc.Some less common trauma include limb twisting or aggressive sneezing.
• Any condition causing the blood coming out of its vessel and accumulating under the tissue can lead to the development of hematoma. The more the blood leakfrom the vessel, the bigger the clot will be.
• Arteries and veins of brain are fragile and sensitive in nature and commonly susceptible to aneurysm (weakening of vessel), leading to blood leak.
• Use of blood thinning agents such as aspirin, warfarin, heparin, clopidogrel, rivaroxaban, etc. can cause spontaneous bleeding and make the body more susceptible to severe hemorrhage after minor injury.
• Substantial decrease in the platelet count (also known as thrombocytopenia), is a condition in which there is inadequate formation of fibrin and thrombin. So a leaked vessel takes time to make a clot over the torn/ damaged spot; thereby leading to large amounts of blood escaping from the vessel to cause hematoma formation.

How Is Hematoma Diagnosed?

1. Physical Examination

The bruises appear on the superficial layer can easily be diagnosed through physical examination. The doctor may ask for the affected site and then physical examination for confirmation of hematoma is performed.

2. Hemogram

Hemogram is performed to evaluate the red blood cell count.

3. Clotting Studies

Clotting studies such as PTT (partial thromboplastin time), INR (international normalized ratio) may be needed. Prothrombin time and INR is generally measured in patients taking blood thinning agents on regular basis. On the basis of these results, the doses of medications are adjusted to prevent hematoma.

4. CT Scan and Ultrasound

CT scan and ultrasound is recommended in patients with intracranial or abdominal hematoma and in pregnant females.

What Are the Treatments for Hematoma?

1. Medical and Surgical Treatment

Specific treatment and medical care is provided after locating the site of hematoma. For example, small blood clots do not require any specific course of therapy, while serious injuries may require surgical intervention or aggressive medical therapy.

2. Home Care

If the injuries are not complicated and bruises are appearing over superficial layer of skin, then simple home based techniques can be utilized to treat the problem.

A common method to treat hematoma on home basis is RICE

• R: Rest.
• I: Ice. Application of cold compress over affected bruised area.
• C: Compression by utilizing bandages.
• E: Elevation. The injured area must be raised above the heart level.