Hematoma: Types, Treatment, Symptoms, & Causes

What Causes Hematomas?

Hematomas commonly result from trauma, but other factors can contribute. Here are the major hematoma causes:

• Injury or Trauma: The most common cause of hematomas is direct physical trauma, such as falls, car accidents, sports injuries, or physical confrontations. When a sudden impact or force is applied to the body, it can break blood vessels under the skin or deeper within tissues, leading to blood pooling in the area. This is why hematomas are common in contact sports or after severe accidents.

• Blood-Thinning Medications: Certain medications, such as anticoagulants (blood thinners), increase the risk of hematomas by slowing down the blood’s ability to clot. These drugs are often prescribed to prevent dangerous blood clots, but they can make it harder for the body to stop bleeding when a blood vessel is injured, leading to a higher likelihood of hematomas, even from minor injuries.

• Health Conditions: Blood disorders like haemophilia, where the blood lacks clotting factors, or liver diseases that interfere with the production of clotting proteins, can make a person more susceptible to hematomas. These conditions impact the body’s natural ability to stop bleeding, so even small injuries may result in larger, more severe hematomas.

• Medical Procedures: Surgeries, injections, or any invasive procedure can inadvertently damage blood vessels, leading to hematomas at or near the site of the procedure. For example, blood might collect under the skin or in deeper tissues after surgery due to vessel injury during the operation. Similarly, injections that accidentally hit a blood vessel can cause blood to leak into surrounding tissue, forming a hematoma.

Types of Hematomas

The location of a hematoma affects its symptoms and potential complications. Here is a list of hematoma types:

• Subcutaneous Hematoma: Found just beneath the skin, a subcutaneous hematoma looks like a large bruise and results from trauma that damages blood vessels close to the skin’s surface. While often harmless, larger subcutaneous hematomas can cause significant discomfort and swelling, sometimes requiring drainage if they don’t resolve on their own.

• Intracranial Hematoma: This type of hematoma forms within the skull and can quickly become life-threatening. Blood pooling inside the skull increases pressure on the brain, which can lead to severe neurological symptoms such as intense headaches, confusion, seizures, and, in severe cases, coma. Without prompt intervention, an intracranial hematoma can cause permanent brain damage or even be fatal. Treatment usually involves surgical drainage to relieve the pressure and prevent further injury to the brain. Because symptoms may not always appear immediately after a head injury, it’s essential to monitor for signs of deterioration and seek medical attention right away if symptoms develop.

• Subungual Hematoma: Located under a fingernail or toenail, subungual hematomas commonly occur after crush injuries, like slamming a finger into a door. These can be very painful due to the buildup of blood under the nail, creating pressure. In severe cases, a doctor may need to drain the blood to relieve pain and prevent nail loss.

• Intra-abdominal Hematoma: Found inside the abdominal cavity, these hematomas are often the result of internal bleeding from blunt trauma to the abdomen, such as in car accidents or falls. Intra-abdominal hematomas can be difficult to detect and may lead to significant complications if they press on internal organs or obstruct blood flow, often requiring imaging tests and possibly surgery.

• Intramuscular Hematoma: This type forms within a muscle, usually due to direct trauma or injury, causing localized pain, swelling, and restricted movement. Depending on its size and location, an intramuscular hematoma may take longer to heal and might benefit from physical therapy for optimal recovery.

• Septal Hematoma: Located in the nose between the nostrils, a septal hematoma forms after a nasal injury, like a broken nose. Left untreated, it can disrupt blood flow to the nasal tissue, potentially causing cartilage damage and nasal deformity. Septal hematomas usually require prompt drainage to avoid complications.

• Auricular Hematoma: Commonly seen in contact sports like wrestling or rugby, an auricular hematoma forms when blood accumulates between the cartilage and skin of the outer ear after blunt trauma. If left untreated, the pressure from the blood buildup can block the blood supply to the cartilage, causing it to die and resulting in a permanent deformity known as the “cauliflower ear.” Not only does this affect the ear’s appearance, but it can also impair hearing and increase the risk of future infections. Timely treatment, often involving drainage and compression, can prevent these complications and preserve ear structure and function

How Hematomas Are Diagnosed

Most of the time, doctors can diagnose a hematoma by simply examining the injured area. They’ll look for swelling, bruising, and tenderness to help determine the extent of the injury. But for more severe cases, or if the hematoma is deep inside the body, imaging tests may be needed to understand how serious the injury is. Here’s how they do it:

• MRI (Magnetic Resonance Imaging): For brain injuries, like a brain hematoma (subdural hematoma), an MRI is often the go-to test. It gives detailed images of the brain and soft tissues, showing the size and location of the hematoma, and helps doctors decide if it’s putting pressure on the brain.

• CT Scan (Computed Tomography): If someone is experiencing a serious head injury, a CT scan can quickly reveal internal bleeding or a subdural hematoma, providing doctors with immediate information to guide treatment decisions.

• Ultrasound: For hematomas in areas like muscles (intramuscular hematomas) or under the skin, an ultrasound is often used to assess the size and location of the swelling and check for any complications.

These tests help doctors determine whether the hematoma can heal on its own or if it requires more urgent medical attention, like draining the blood or surgery.
 

Common Symptoms of Hematomas

Symptoms vary by location, but general signs include:

• Pain and Swelling: Hematomas are typically painful and swollen, and the area may be tender.

• Skin Discoloration: Hematomas near the skin appear red, purple, or blue.

• Pressure Symptoms: Large hematomas may press on nerves, increasing discomfort.

Serious Symptoms of Intracranial Hematomas

• Severe headache

• Vomiting

• Confusion or dizziness

• Slurred speech

• Unequal pupil sizes

Consult our internal medicine specialist in Jaipur if you are experiencing hematoma symptoms. 

Risks of Untreated Hematomas

While many hematomas heal without causing problems, leaving them untreated, especially if they're large or in critical areas, can lead to complications. Here’s why you should seek medical attention if you have a hematoma:

• Infection: If a hematoma gets infected, you could see increased pain, redness, warmth, or even pus. This is more common with superficial hematomas (like subungual hematomas under the nails or auricular hematomas in the ear). Infections may require antibiotics or drainage.

• Tissue Damage: If a hematoma isn’t properly treated, the blood can press on surrounding tissues and cause damage. Over time, this may lead to long-term pain or limited movement, especially if it’s in a muscle or joint.

• Chronic Pain: Some hematomas, particularly intramuscular hematomas (in muscles), can leave behind lingering pain or stiffness if not managed properly. Left unchecked, it could even affect your range of motion.

• Brain Hematomas: For brain hematomas, such as subdural hematomas, if the blood pressure inside the skull keeps increasing, it can cause severe brain damage. In the worst-case scenario, it could even be fatal. Immediate treatment is crucial to prevent long-term damage.

How Lifestyle and Health Factors Affect Hematoma Risk

Certain health conditions and lifestyle factors can increase your chances of developing a hematoma:

• Age: Older adults are more prone to hematomas because their skin is thinner and their blood vessels are more fragile. Additionally, as we age, our bodies heal more slowly, which can make recovery longer.

• Diet: A poor diet lacking essential nutrients like vitamin C, vitamin K, or calcium can weaken blood vessels, making bruising and hematomas more likely. Eating a balanced diet can help strengthen your blood vessels and improve healing.

• Physical Activity: If you’re active, especially in high-contact sports, you might be at greater risk for traumatic injuries. Athletes, for instance, are more likely to suffer from muscle hematomas or bruises that develop into hematomas.

• Health Conditions: People with blood disorders like haemophilia or those on blood-thinning medications (such as anticoagulants) are at a much higher risk of developing hematomas, even from minor injuries. These conditions make it harder for your body to stop bleeding and heal injuries.

Preventing Hematomas: Quick Tips for Safety

• Wear Protective Gear: Helmets, pads, and other gear can prevent injuries that lead to hematomas, especially in contact sports or high-risk activities.

• Build Bone and Muscle Strength: Exercise regularly and consume calcium and vitamin D to strengthen bones, reducing injury risk.

• Monitor Medications: Blood thinners increase hematoma risk. Discuss with your doctor the best way to manage these safely.

• Stay Safe at Home: Prevent falls by securing rugs, using handrails, and removing clutter, especially for older adults.

• Follow Post-Procedure Care: After injections or surgeries, follow care instructions (like resting and icing) to avoid hematomas.

How Are Hematomas Treated?

Treatment depends on the hematoma's size and location:

• Rest and Ice: Minor hematomas can often be managed with rest, ice, compression, and elevation (R.I.C.E.).

• Pain Relief: Over-the-counter pain relievers can help with discomfort.

• Drainage: Large or problematic hematomas may need to be drained by a doctor.

• Surgery: In severe cases, such as brain hematomas, surgery may be required to remove the clot and prevent further bleeding.

• Medications: Clotting medications may be used in certain cases to control bleeding.

Consult our internal medicine hospital in Jaipur if you need hematoma treatment. 

Recovery Timeline and What to Expect

Hematomas can take time to heal, and how long it takes depends on how big or deep the hematoma is. Here's a quick breakdown of what to expect:

• First few days (1-3 days): The area will be swollen, red, and possibly warm to the touch due to the body's natural inflammatory response. You'll likely feel some pain or tenderness.

• Bruising Phase (3-7 days): Over the next few days, the color of the hematoma will change. It will likely go from red to purple or blue as the blood under the skin breaks down. Swelling and pain should start to decrease, but some discomfort may remain.

• Healing Phase (7-14 days): During this time, the hematoma will start to turn yellow or green as the blood is reabsorbed by the body. The swelling and pain should be significantly reduced, although it may still feel a little sore.

• Full Recovery (2-4 weeks): Most small hematomas will be fully healed within a month. However, larger or deeper hematomas, like subdural hematomas in the brain, may take much longer to heal and could require medical intervention.

If you have a brain hematoma, it’s important to note that recovery can take longer. Subdural hematomas, for example, may require surgery to relieve pressure on the brain and can take weeks or even months to fully heal, depending on the severity.

Conclusion

Hematomas, whether minor or severe, require careful attention. Early diagnosis and treatment help prevent complications and support recovery. If you suspect a hematoma, consulting a healthcare provider is important to determine the best treatment plan.