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Key Highlights

• Hematomas are localized collections of blood outside blood vessels, often resulting from trauma or injury.
• Types of hematomas vary by location, including subdermal, intramuscular, intracranial, and abdominal, each presenting unique symptoms and requiring tailored treatment.
• Treatment ranges from conservative methods like R.I.C.E. (rest, ice, compression, elevation) to surgical interventions, depending on the hematoma's severity and location.

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What is a Hematoma?

A hematoma is a localized collection of blood outside of blood vessels, typically occurring due to trauma, injury, or surgery. When a blood vessel wall is damaged—whether it's an artery, vein, or capillary—blood leaks into the surrounding tissues, leading to the formation of a hematoma. This pooling of blood can occur under the skin, in muscles, or even within organs.

A bruise on the knee, a common example of a hematoma.

Hematomas are often benign and resolve over time as the blood is reabsorbed by the body. However, depending on their size, location, and associated symptoms, they may require medical intervention. Unlike a hemorrhage, where bleeding is ongoing, a hematoma typically involves blood that has already clotted.

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Causes and Risk Factors

The primary cause of a hematoma is damage to blood vessels, leading to blood leakage into surrounding tissues. This damage can result from various factors, including:

• Trauma or Injury: Direct impacts from accidents, falls, or blows to the body are common causes.
• Surgical Procedures: Any surgery, invasive medical procedure, or dental work can cause hematomas.
• Medications: Injections, such as insulin, blood thinners, or vaccines, can sometimes lead to hematoma formation.
• Underlying Conditions: Clotting disorders like hemophilia, blood vessel tearing (aortic dissections), and blood cancers like leukemia can increase the risk of hematomas.

Certain activities and conditions can increase the likelihood of developing a hematoma. For instance, athletes involved in contact sports are at higher risk due to the increased potential for physical trauma. Individuals with conditions affecting blood clotting or those on anticoagulant medications also face an elevated risk.

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Types of Hematomas

Hematomas are categorized based on their location in the body. Different types of hematomas include:

Subcutaneous Hematoma

A subcutaneous hematoma occurs just beneath the skin, usually due to direct trauma or injury. These are the most common types of hematomas and are often visible as bruises.

Intramuscular Hematoma

This type of hematoma develops within muscle tissue, often due to trauma or vigorous physical activity. Intramuscular hematomas can cause pain, swelling, and limited range of motion.

Intracranial Hematoma

Intracranial hematomas occur inside the skull or brain and are among the most serious types. They can result from head injuries and are categorized into:

• Epidural Hematoma: Located between the skull and the dura mater (the outer layer of the membranes surrounding the brain). These are often associated with skull fractures.
• Subdural Hematoma: Occurs between the dura mater and the arachnoid mater (the middle layer of the meninges).
• Intracerebral Hematoma: Located within the brain tissue itself.

Other Types of Hematomas

• Retroperitoneal Hematoma: Occurs inside the abdominal cavity but not within any organs.
• Splenic Hematoma: Appears in the spleen.
• Subungual Hematoma: Occurs under the fingernail or toenail, usually from a crush injury.
• Auricular Hematoma: Affects the ear, potentially leading to deformity if not treated.
• Septal Hematoma: Blood collects in the area of the nose between the nostrils (septum).

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Symptoms and Diagnosis

The symptoms of a hematoma vary depending on its location, size, and underlying cause. Common symptoms include:

• Pain: Often due to inflammation and pressure on surrounding tissues.
• Swelling: Accumulation of blood can cause noticeable swelling in the affected area.
• Discoloration: Bruises may appear purplish, bluish, or blackish.
• Limited Range of Motion: Hematomas near joints or muscles can restrict movement.
• Headache and Confusion: In cases of intracranial hematomas, symptoms may include headache, confusion, dizziness, and other neurological signs.

Diagnosis typically involves a physical examination and imaging tests. Common diagnostic methods include:

• Physical Examination: A healthcare provider will assess the area for signs of swelling, discoloration, and tenderness.
• CT Scan: Used to detect hematomas, especially intracranial ones, and assess their size and location.
• MRI: More reliable in detecting epidural hematomas and soft tissue hematomas.
• Ultrasound: Can help visualize hematomas in soft tissues.

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Treatment Options

Treatment for a hematoma depends on its type, location, and severity. Options range from conservative management to surgical intervention.

Conservative Management

For minor hematomas, the R.I.C.E. method is often recommended:

• Rest: Avoid using the injured area to allow it to heal.
• Ice: Apply ice packs wrapped in a towel to reduce swelling and pain.
• Compression: Use a bandage to compress the area, which can help reduce swelling.
• Elevation: Elevate the injured area above heart level to minimize swelling.

Over-the-counter pain medications like acetaminophen (Tylenol) can help manage pain. Wound care, including cleaning the injury and applying a bandage, is essential for superficial hematomas.

Surgical Intervention

Some hematomas require surgical drainage, especially if they are large, cause significant pain, or compress surrounding structures. Surgical options include:

• Surgical Drainage: Involves making an incision to drain the accumulated blood.
• Craniotomy: Used for subdural hematomas that develop soon after a severe head injury, involving the removal of a portion of the skull to access and remove the blood.
• Burr Holes: Small holes drilled into the skull to drain liquid blood.
• Arterial Embolization: A less invasive treatment option for muscular hematomas, which involves blocking the bleeding artery.

If a hematoma is associated with a broken nail (subungual hematoma), trephination (drilling a small hole in the nail) may be performed to relieve pressure.

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Prevention Strategies

While some hematomas are unavoidable, several measures can reduce the risk of their occurrence:

• Protect Vulnerable Areas: Use protective padding or garments if you have areas of your body prone to hematomas.
• Prompt Treatment of Underlying Conditions: Manage conditions affecting blood clotting effectively with your healthcare provider.
• Take Precautions: Be cautious during activities that may cause trauma, such as sports or manual labor.
• Home Safety: Ensure a safe home environment to prevent falls and injuries, especially for older adults.

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Complications and When to Seek Medical Attention

Most hematomas are harmless and resolve on their own, but some can lead to complications, including:

• Infection: If the skin is broken, infection can occur.
• Nerve Damage: Hematomas can compress nerves, leading to pain, numbness, or weakness.
• Compartment Syndrome: Increased pressure within a muscle compartment can compromise blood supply.
• Deformity: Untreated auricular hematomas can cause "cauliflower ear."

Seek medical attention if you experience any of the following:

• Severe Pain or Swelling: Especially if it worsens over time.
• Neurological Symptoms: Such as headache, confusion, dizziness, or weakness.
• Signs of Infection: Including fever, redness, or pus.
• Rapidly Growing Hematoma: Suggests significant blood leakage.

Prompt medical evaluation is crucial to determine the appropriate treatment and prevent potential complications.

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The Role of Rehabilitation and Physical Therapy

Following the resolution of a hematoma, rehabilitation and physical therapy may be recommended, particularly for hematomas that have caused muscle or joint impairments. The goals of rehabilitation include restoring mobility, strength, and function in the affected area.

This YouTube video provides an overview of hematomas, including their causes, symptoms, diagnosis, and treatment. It is relevant as it offers a concise and informative summary of hematomas, aiding in understanding the condition and its management.

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Summary of Hematoma Types, Causes, and Treatments

Here's a summary table of hematoma types, causes, and treatments:

Type of Hematoma	Common Causes	Typical Treatments
Subcutaneous	Trauma, injury	R.I.C.E. method, pain medication
Intramuscular	Trauma, vigorous activity	R.I.C.E. method, physical therapy
Epidural (Intracranial)	Head injury, skull fracture	Surgery (craniotomy, burr holes)
Subdural (Intracranial)	Head injury	Surgery (craniotomy, burr holes)
Subungual	Crush injury to finger or toe	Trephination (nail drilling)
Auricular	Trauma to the ear	Drainage, antibiotics

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FAQ

What is the main difference between a hematoma and a bruise?

A bruise involves localized bleeding from smaller blood vessels and typically doesn't require treatment, whereas a hematoma is a larger collection of blood outside of blood vessels that may require medical intervention.

When should I seek medical attention for a hematoma?

Seek medical attention if you experience severe pain, swelling, neurological symptoms, signs of infection, or a rapidly growing hematoma.

Can hematomas be prevented?

While some hematomas are unavoidable, you can reduce the risk by protecting vulnerable areas, managing underlying conditions, taking precautions during activities that may cause trauma, and ensuring a safe home environment.

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References

• Hematoma Definition, Types & Treatment - Cleveland Clinic
• Hematoma: Overview, types, treatment, and pictures - Medical News Today
• Hematoma: Types, Treatment, Symptoms, Pictures & Causes - RxList
• Hematoma Symptoms and Causes Comprehensive Information - Larkin Health
• Hematoma: Causes and Severity Based on Type - Verywell Health