Understanding Hematomas: Causes, Types, and Treatments

Key Highlights About Hematomas

Hematomas are collections of blood outside blood vessels, often caused by trauma but sometimes by underlying conditions. They can range from minor bruises to serious internal bleeding.
Different types of hematomas exist, classified by their location, such as subcutaneous, intramuscular, and intracranial. Intracranial hematomas, in particular, require immediate medical attention.
Treatment varies depending on the hematoma's severity and location, ranging from R.I.C.E. therapy for minor cases to surgical intervention for more serious ones. Early diagnosis and appropriate management are crucial for preventing complications.

What is a Hematoma?

A hematoma is a localized collection of blood outside of blood vessels, typically resulting from damage to the vessel walls. This damage causes blood to leak into the surrounding tissues, leading to a clot or pool of blood. Hematomas can occur in various parts of the body and can range from minor, superficial bruises to more severe, deep-tissue collections of blood.

While many hematomas are benign and resolve on their own, some can indicate a more serious underlying issue, especially if they occur internally or are associated with significant trauma. Understanding the causes, types, and appropriate treatments for hematomas is essential for proper management and prevention of complications.

Causes and Risk Factors

Hematomas are commonly caused by trauma or injury that damages blood vessels, leading to blood leakage into surrounding tissues. However, other factors can also contribute to their formation.

Trauma and Injury

Direct blows, falls, car accidents, and sports injuries are common causes of hematomas. The impact from these events can damage blood vessels, causing them to rupture and leak blood into the surrounding tissues. More severe traumas can cause more major hematomas, such as falling from a height or getting into a motor vehicle accident, which can cause noticeable bleeding under the skin or inside body cavities.

Trauma is the primary cause of hematomas.

Medical Procedures

Invasive medical or dental procedures, such as surgeries, biopsies, incision and drainage, cardiac catheterization, and injections of medications (e.g., insulin, blood thinners, vaccines), can also result in hematomas. These procedures may inadvertently damage blood vessels, leading to blood leakage and hematoma formation. Hematomas can also occur as a complication of invasive procedures such as angiograms or catheter insertions.

Underlying Medical Conditions

Certain medical conditions that affect blood clotting, such as hemophilia or other clotting disorders, can increase the risk of hematomas. Additionally, conditions that weaken blood vessels, such as aneurysms or vascular malformations, can also make individuals more prone to developing hematomas. It's also worth noting that the use of blood-thinning medications can increase the likelihood of hematoma formation even from minor injuries.

Other Risk Factors

Factors like age, skin fragility, and nutritional deficiencies can also increase the risk of hematomas. Older adults, for example, may have more fragile blood vessels that are more susceptible to damage. Individuals with thin or fragile skin may benefit from using protective padding or garments to minimize the risk of trauma.

Types of Hematomas

Hematomas are classified based on their location and the tissues or spaces in which the blood collects. Different types of hematomas can present varying levels of severity and may require different treatment approaches. Here are some common types of hematomas:

Subcutaneous Hematoma

This type of hematoma occurs beneath the skin, usually due to direct trauma or injury. Subcutaneous hematomas are often visible as bruising or discoloration of the skin. Hematomas of the skin and soft tissues are often treated with rest, ice, compression, and elevation (RICE).

Intramuscular Hematoma

An intramuscular hematoma develops within the muscle tissue, often due to trauma or vigorous physical activity. These hematomas can be painful because of inflammation, swelling, and irritation. If the blood supply in the muscle is affected, nerves can be harmed. This type of hematoma is often seen in the lower legs and lower arms. Muscular hematomas are in simple terms defined by bleeding within a muscle group.

Intracranial Hematoma

Intracranial hematomas occur inside the skull and can be particularly dangerous due to the limited space within the skull. Because the skull is an enclosed container, anything that takes up space increases pressure within and potentially impairs the ability of the brain to function. Examples of intracranial hematomas include subdural hematoma, epidural hematoma, and intracerebral hematoma.

Illustration of an intracranial hematoma.

Subdural Hematoma

A subdural hematoma is a type of intracranial hematoma that occurs when blood collects between the brain and the dura mater (a protective membrane covering the brain). Subdural hematomas are usually caused by a head injury. Head injuries that cause subdural hematomas are often severe, such as from a car crash.

Epidural Hematoma

In an epidural hematoma, blood pools between the skull and the dura mater (the outermost layer of the meninges, or protective membranes, surrounding the brain and spinal cord). In 75 percent of cases, an epidural hematoma is associated with skull fracture; the condition generally is considered to be a type of traumatic brain injury. Epidural hematomas occur because of trauma, often to the temple, where the middle meningeal artery runs.

Intracerebral Hematoma

An intracerebral hematoma occurs within the brain tissue itself. The most common cause of an intracranial hematoma is a head injury. A head injury that causes bleeding within the skull may result from motor vehicle accidents or falls.

Other Types of Hematomas

Besides the common types mentioned above, other hematomas can occur in specific areas of the body.

Subungual Hematoma

Subungual hematomas are the result of crush injuries to the fingers or toes. Bleeding from this type of injury occurs under the fingernail or toenail, and because it is trapped, pressure builds up, causing pain. Large subungual hematomas that are left in place can sometimes compromise the nail and result in the nail dying and falling out.

Septal Hematoma

In this hematoma, blood collects in the area of the nose between the nostrils (septum). The cover of the septal cartilage (mucoperichondrium) separates from the cartilage, causing blood to pool. This type of hematoma is most often from a broken nose or a complication from septum surgery.

Aural Hematoma

A hematoma in the ear can affect the blood supply and cause the tissues of the ear to die. It can also cause deformity (“cauliflower ear”).

Symptoms of a Hematoma

The symptoms of a hematoma can vary depending on its location, size, and underlying cause. Here are some common symptoms associated with hematomas:

Pain: Hematomas can cause pain in the affected area due to the pressure and inflammation caused by the accumulated blood.
Swelling: Swelling is a common symptom of hematomas, as the blood pools and causes the surrounding tissues to expand.
Discoloration: Hematomas often result in discoloration of the skin, ranging from red or purple to black or blue. Over time, the discoloration may change as the blood is reabsorbed by the body.
Tenderness: The affected area may be tender to the touch, and pressure on the hematoma can exacerbate the pain.
Limited Range of Motion: Hematomas that occur near joints or muscles can limit range of motion and make it difficult to move the affected limb or body part.
Headache and Confusion: In cases of intracranial hematomas, symptoms may include headache, confusion, dizziness, and other neurological signs, indicating increased intracranial pressure.

Symptoms may not appear immediately, but they generally appear after a couple of days.

Diagnosis and Treatment Options

The diagnosis and treatment of hematomas depend on their type, location, severity, and the presence of any underlying medical conditions.

Diagnostic Methods

A physical examination is typically the first step in diagnosing a hematoma. The doctor will assess the affected area, looking for signs of swelling, discoloration, and tenderness. Additional diagnostic tests may be necessary to confirm the diagnosis and determine the extent of the hematoma.

Imaging Tests: Imaging tests such as X-rays, CT scans, and MRI scans may be used to visualize the hematoma and assess its size, location, and any associated injuries.
Blood Tests: Blood tests may be performed to evaluate blood clotting function and identify any underlying bleeding disorders that may have contributed to the hematoma.

Treatment Approaches

The treatment approach for hematomas varies depending on the severity and location of the hematoma. In many cases, conservative management may be sufficient, while more severe hematomas may require medical intervention.

R.I.C.E. Therapy: For minor hematomas, the R.I.C.E. (Rest, Ice, Compression, Elevation) method is often the first line of treatment. This involves resting the injured area, applying ice packs to reduce swelling, compressing the area with a bandage, and elevating it to promote drainage.
Pain Management: Over-the-counter pain medications, such as acetaminophen (Tylenol), can be used to alleviate pain and discomfort associated with hematomas.

Over-the-counter pain medications can help manage pain from a hematoma.

Medical or Surgical Intervention

In some cases, medical or surgical intervention may be necessary to manage a hematoma. The presence of symptoms and location of the hematoma generally dictate what type of procedure is needed and how urgently it needs to be done.

Drainage: Large or symptomatic hematomas may require drainage to relieve pressure and promote healing. This can be done through needle aspiration or surgical incision and drainage.
Surgery: In cases of intracranial hematomas or other severe hematomas, surgery may be necessary to remove the blood clot and repair any damaged blood vessels or tissues. A craniotomy is the main treatment for subdural haematomas that develop soon after a severe head injury (acute subdural haematomas).

Below is a table summarizing different types of hematomas, their common causes, and typical treatment approaches:

Type of Hematoma	Common Causes	Typical Treatment
Subcutaneous Hematoma	Direct trauma, injury	R.I.C.E. therapy, pain management
Intramuscular Hematoma	Trauma, vigorous physical activity	R.I.C.E. therapy, physical therapy
Subdural Hematoma	Head injury	Surgical drainage, monitoring
Epidural Hematoma	Skull fracture, head trauma	Emergency surgery
Subungual Hematoma	Crush injuries to fingers or toes	Trephination (drilling a hole)

Prevention Strategies

While some hematomas may be unavoidable due to unforeseen accidents or underlying medical conditions, there are measures you can take to help prevent hematomas or reduce the risk of their occurrence:

Protecting Vulnerable Areas: Take extra precautions if you have areas of your body that are particularly prone to hematomas or have underlying conditions that increase the risk.
Prompt Treatment of Underlying Conditions: If you have underlying medical conditions that affect blood clotting, such as hemophilia or clotting disorders, work closely with your healthcare provider to manage these conditions effectively.
Fall Prevention: Taking steps to prevent falls, such as removing tripping hazards, using assistive devices, and improving balance, can help reduce the risk of hematomas, especially in older adults.

Frequently Asked Questions (FAQ)

When should I seek medical attention for a hematoma?

Seek medical attention if the hematoma is large, painful, or located in a sensitive area such as the head or abdomen. Also, consult a doctor if you experience symptoms such as severe pain, swelling, numbness, or signs of infection.

How long does it take for a hematoma to heal?

The healing time for a hematoma varies depending on its size, location, and severity. Minor hematomas may resolve within a few weeks, while larger or deeper hematomas may take several months to heal. Healing time will vary depending on the individual and the type of hematoma.

Can I drain a hematoma at home?

It is generally not recommended to drain a hematoma at home, as this can increase the risk of infection or other complications. Medical professionals are trained to safely drain hematomas using sterile techniques.

Are there any natural remedies for hematomas?

Some natural remedies, such as arnica cream or bromelain supplements, may help reduce inflammation and promote healing of hematomas. However, it is important to consult with a healthcare professional before using any alternative treatments.