Hematoma – Causes, Risk Factors, Treatment, and Prevention.

What is 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. It 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. It 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. It may sometimes form a mass or lump that can be felt.

 

Types

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

• Ear hematoma: An aural or ear hematoma appears between the cartilage of the ear and the skin on top of it. It is a common injury in wrestlers, boxers, and other athletes who regularly sustain blows to the head.

• Subungual hematoma: It appears under the nail. It is common in minor injuries, such as accidentally hitting a finger with a hammer.
• Scalp hematoma: A scalp hematoma typically appears as a bump on the head. The damage is to the external skin and muscle, so it will not affect the brain.
• Septal hematoma: Usually the result of a broken nose, a septal hematoma may cause nasal problems if a person does not receive treatment.
• Subcutaneous hematoma: This type appears just under the skin, typically in the shallow veins close to the surface of the skin.
• Retroperitoneal hematoma: It occurs inside the abdominal cavity but not within any organs.
• Splenic hematoma: This type of hematoma appears in the spleen.
• Hepatic hematoma: A hepatic hematoma occurs in the liver.
• Spinal epidural hematoma: This term refers to a hematoma between the lining of the spinal cord and the vertebrae.
• Intracranial epidural hematoma: It occurs between the skull plate and the lining on the outside of the brain.
• Subdural hematoma: It occurs between the brain tissue and the internal lining of the brain.

What causes a hematoma?

When a blood vessel ruptures or is injured, blood can leak into the surrounding tissue where it collects and forms a hematoma. The most common cause of a hematoma is trauma or injury. A minor injury that affects small blood vessels, like capillaries in the skin, can result in a bruise. Injury to larger vessels can cause much more bleeding (hemorrhage) and larger hematomas, and injuries to the head can cause a hematoma to form inside the skull, which can compress the brain.

It may also form if your blood cannot clot properly because of a coagulation disorder, anticoagulant medications, or chronic disease.

Common causes of hematoma

Hematoma may be caused by a variety of conditions including:

• Anticoagulation medications, such as warfarin (Coumadin) or heparin
• Blood draw procedure (venipuncture) or intravenous catheter insertion
• Chronic diseases
• Coagulation disorders, such as hemophilia or Von Willebrand’s disease (hereditary bleeding disorder)
• Platelet deficiency (platelets are part of the normal blood clotting process)
• Trauma or injury

Serious or life-threatening causes of hematoma

In some cases, it may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include head trauma resulting in a skull hematoma or a pelvic fracture wherein a large quantity of blood can quickly accumulate unnoticed.

Risk factors of hematoma

The following increase the risk:

• Medicines that thin the blood (such as warfarin or aspirin)
• Long-term alcohol use
• Medical conditions that make your blood clot poorly
• Repeated head injury, such as from falls
• Very young or very old age
• Epilepsy
• Coagulopathy
• Arachnoid cysts
• Cardiovascular disease (eg, hypertension, arteriosclerosis)
• Thrombocytopenia
• Diabetes mellitus

Symptoms

For more superficial hematomas, symptoms include:

• Discoloration
• Inflammation and swelling
• Tenderness in the area
• Redness
• Warmth in the skin surrounding the hematoma
• Pain

Internal hematomas may be more difficult to recognize. Anyone who has been in an accident or sustained a serious injury should regularly check in with a doctor to screen for hematomas.

Hematomas in the skull may be particularly dangerous. Even after seeing a doctor about an injury, it is essential to keep an eye out for new symptoms, such as:

• A severe, worsening headache
• Uneven pupils
• Difficulty moving an arm or leg
• Hearing loss
• Difficulty swallowing
• Sleepiness
• Drowsiness
• Loss of consciousness

Symptoms may not present immediately, but they usually appear within the first few days.

What are the potential complications of hematoma?

Mild hematomas or bruises are generally free of complications in healthy individuals. Larger or severe hematomas can have more serious complications, including hypovolemic shock from internal blood loss

or infection. Hematomas inside the head can cause life-threatening complications.

Because it can be due to serious diseases, failure to seek treatment can result in life-threatening complications and permanent damage. Your primary healthcare provider will likely order blood tests, internal imaging tests (MRI, ultrasound or CT scan) or may refer you to a hematologist, a doctor who specializes in blood and bleeding conditions.

Once the underlying cause is diagnosed, it is important for you to follow your treatment plan to reduce the risk of potential complications including:

• Anemia
• Cardiac arrest
• Coma
• Permanent disability
• Respiratory arrest

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. 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 it is in the abdominal cavity (intra-abdominal, hepatic, splenic, retroperitoneal, and 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 clinical situation. Some may require no treatment at all while others may be deemed a medical emergency.

Can I care for myself?

Simple therapies at home may be utilized in treating superficial (under the skin) hematomas. Most injuries and bruises can be treated with resting, icing, compression, and elevating the area. This is remembered by the acronym RICE. These measures usually help to reduce inflammation and diminish its symptoms.

• Rest
• Ice (Apply the ice or cold pack for 20 minutes at a time, 4 to 8 times a day.)
• Compress (Compression can be achieved by using elastic bandages.)
• Elevate (Elevation of the injured area above the level of the heart is recommended.)

When using ice packs, apply the ice or cold pack for 20 minutes at a time, 4 to 8 times a day. Compression can be achieved by using elastic bandages, and elevation of the injured area above the level of the heart is recommended.

What is the medical treatment?

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 due to this disorder can be treated with pain medications such as acetaminophen (Tylenol).

Surgical drainage is a common method of treatment for certain hematomas. The presence of symptoms and location of it 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.

Can it be prevented?

Prevention of all hematomas is not entirely possible. However, prevention in certain contexts deserves special attention.

In people, especially the elderly, who take blood thinners or anti-platelet medications (aspirin or clopidogrel), falls are a common cause of trauma and hematoma formation. Falls can cause hematomas in the legs, chest, or brain, and may, at times, result in significant illness or death. Therefore, measures to prevent falls in this population potentially lower the frequency of hematomas as well.

Children are also at risk to develop hematomas frequently due to falls and minor injuries. In particular, younger children are more prone to bumping their head, causing a small egg-shaped swelling in the area of injury. Therefore, child-proofing the home and furniture may help in decreasing hematomas in children.

Hematoma that results from trauma due to heavy physical work or contact sports is less preventable unless such activities are stopped or modified to reduce the risk of trauma and injury.