Written By: Elena Duran Chao
What is a hematoma?
Localized collections of blood outside of the blood vessels are the hallmark of a common medical disorder known as hematomas. They can occur in various parts of the body such as the skin, muscles, organs and even the brain. A trauma or injury to the body can often result in a hematoma, and understanding the causes, symptoms as well as treatment options for hematomas is crucial to an effective recovery.
Bruise vs Hematoma
Looks may be deceiving. Despite the discoloration of the skin appearing nearly identical, bruises and hematomas have very little in common. Hematomas are frequently considered as a more serious type of bruising because of multiple factors such as healing time and appearance. Although the purpling of skin is akin to that of a bruise, hematomas may also become swollen as a result of active bleeding developed deep within an extremity. Due to the severity of this injury, it may take several months before it is fully recovered. However, a bruise may simply disappear in a couple days.
Causes
1. Trauma
The primary cause of hematomas is physical trauma or injury to the affected area, such as falling, sports injuries, or vehicle accidents. The extent of the injury is determined by the scale of the incident: a hematoma on the leg from a strong hit by a football may not be as in need of medical attention as one from a hit to the chest in a car crash.
2. Surgery
After a surgical procedure, especially those involving major blood vessels or organs, a hematoma may develop. Blood may build up around the surgical site where tissue has been removed during surgery, and may appear between 7 - 10 days after surgery.
3. Medical conditions
People with certain medical conditions, such as hemophilia (a bleeding disorder) or liver disease, may be considered at risk for a hematoma easily occuring, and may require closer attention to each injury.
4. Medications
Specific medication, such as anticoagulants or antiplatelet pills, can interfere with the blood’s clotting ability, making individuals on these drugs more prone to hematomas.
5. Others
Other risk factors may include age, gender, body mass index (BMI), smoking and diabetes. Each could influence the health of a person, and could make some people more liable to be on the receiving end of hematomas.
Types of hematomas
1. Subcutaneous hematomas
These hematomas occur beneath the skin and are commonly visible as bruises or swelling. Falls, hits, accidents or sports injuries often lead to this type of hematoma.
Symptoms may include discoloration of the skin, swelling or tenderness and pain in the wounded area. Less serious ones often resolve in a month while the body works to reabsorb the blood that has leaked from the capillaries.
Treatment options can vary from the RICE method (rest, ice, compression and elevation) to the intake of anti-inflammatory or pain drugs. In addition, observation and close monitoring of the affected area is suggested.
2. Intramuscular hematomas
These hematomas occur within the muscle tissue as a result of direct trauma or muscle strain. These hematomas usually affect athletes, individuals involved in high-impact activities, or those experiencing repetitive stress.
While intramuscular hematomas may present as a sprain, imaging techniques, such as an X-ray or MRI, can aid in diagnosis. Localized pain and swelling can also indicate that an intramuscular hematoma has formed. A loss in range of motion and stiffness in the affected extremity could happen a few days after the trauma has been inflicted.
Physical therapy, stretching exercises and rest are effective treatment methods to relieve the intramuscular hematomas. Pain management through medication may also be used if necessary.
3. Subdural and Epidural hematomas
Subdural and epidural hematomas are both generally caused by head traumas or skull fractures. However, not all head injuries cause one; only around 30 - 40% of head injury patients acquire an intracranial hematoma. Although their symptoms and treatment methods are alike, the two hematomas occur in different parts of the head.
Subdural hematomas may develop in the area between the brain and the outermost covering (the dura mater). This type of hematoma is often considered the most lethal, as the mortality rate can range from 50 - 90% after suffering one.
On the other hand, epidural hematomas involve bleeding between the skull and the dura mater. Despite the fact that subdural hematomas are the leading cause of death after head trauma, epidural hematomas are just as fatal, and can cause instantaneous death on impact.
Before diagnosis, CT scans and MRIs are essential for identifying the injury. Nonetheless, symptoms that may clearly indicate either one of the hematomas include headaches, dizziness, confusion, nausea, seizures or focal deficits.
These types of hematomas are much more dangerous than the others, and may require immediate medical attention as well as neurosurgical intervention. Postoperative monitoring and rehabilitation may also be necessary.
4. Subungual hematomas
This type of hematoma can be seen under fingernails or toenails, often due to crush injuries or repeated trauma.
When a subungual hematoma is sustained, the person may feel pain, discoloration and swelling under the nail.
Depending on the size of the hematoma, treatment options may vary. Pain management can be used for smaller scale injuries, but for larger scale injuries, an evacuation of the hematoma may be necessary.
A Summary on Hematomas: What have you learned?
Hematomas are created when a localized area of bleeding occurs in certain extremities of the body, most likely due to trauma. There are multiple types of hematomas which people may experience, and each hematoma comes with its own set of symptoms and treatment options. Having an understanding of the causes, prognostics and management strategies associated with each hematoma allows medical professionals and patients to effectively address these conditions. As individual cases may differ, consulting healthcare professionals for a proper diagnosis and an appropriate course of treatment for hematomas is always recommended.
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