What is a 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. A hematoma 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.
Hematomas 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.
Sometimes hematomas are named based on their location. Some examples include:

Subdural hematoma: a hematoma between the brain tissue and the inside lining of the
brain
Spinal epidural hematoma: a hematoma between spinal vertebrae and the outside lining
of the spinal cord
Intracranial epidural hematoma: a hematoma between the skull and the outside lining
of the brain
Subungual hematoma: a hematoma under the nail
Intra-abdominal, peritoneal, or retroperitoneal hematoma: a hematmoa inside the
abdominal cavity
Ear or aural hematoma: a hematoma between the ear cartilage and overlying skin
Splenic hematoma: a hematoma within the spleen
Hepatic hematoma: a hematoma within the liver

Most hematomas resolve spontaneously over time as the blood debris is removed and the blood
vessel wall is repaired by the body's repair mechanisms. Other times, removing or evacuating the
blood in a hematoma becomes necessary based on its symptoms or location.

What are the causes of hematoma?

The most common cause of a hematoma is injury or trauma to blood vessels. This can happen as
a result of any damage to blood vessels that can disrupt the integrity of the blood vessel wall.
Even minimal damage to a small blood vessel can result in a hematoma. For example, a
hematoma under a nail (subungual hematoma) can simply occur from minor trauma to the nail or
from a light stroke against an object.
More severe traumas can cause more major hematomas. Falling from a height or getting into a
motor vehicle accident can cause noticeably large bleeding under the skin or inside body cavities
(chest or abdomen).

Other types of tissue injury causing a hematoma can result from surgeries of any sort, invasive
medical or dental procedures (for example, biopsies, incision and drainage, cardiac
catheterization), and injection of mediations (for example, insulin, blood thinners, vaccines).
Because these procedures damage nearby tissues and blood vessels, often hematomas may form
around the site of the procedure.
Occasionally, a hematoma may happen spontaneously without any identifiable cause or
recollection of any specific injury or trauma.
Certain blood thinner medications can increase the risk of hematoma formation. People who take
medications such as warfarin (Coumadin), clopidogrel (Plavix), aspirin, aspirin-containing
products (Alka Seltzer), or dipyridamole (Persantine) may develop a hematoma much easier and
with less severe injury to their blood vessels than other people. Because of the tendency of these
medications to impair the clotting ability of the blood, minor damage to the blood vessel
becomes more difficult to repair, resulting in hematoma formation.
Other common medications and supplements that may increase bleeding tendencies include
vitamin E, nonsteroidal anti-inflammatory drugs or NSAIDs (ibuprofen, Motrin, Advil, Aleve),
garlic supplements, and ginkgo biloba.
There are also certain medical conditions that may pose an additional risk for developing
hematomas. Individuals with chronic (long standing) liver disease, excessive alcohol use,
bleeding disorders (hemophilia, Von Willebrand Disease), blood cancers, or low platelet count
(thrombocytopenia) are potentially at higher risk for hematoma formation.
In summary, a list of medications causing excess bleeding include:

warfarin (Coumadin),
clopidogrel (Plavix),
aspirin,
aspirin-containing products (Alka Seltzer),
dipyridamole (Persantine),
vitamin E,
nonsteroidal anti-inflammatory drugs or NSAIDs (ibuprofen, Motrin, Advil, Aleve),
garlic supplements, and
ginkgo biloba.

Common medical conditions with increased bleeding potential are:

chronic liver disease,

excessive alcohol use,
bleeding disorders,
blood cancers, and
low platelet count (thrombocytopenia).

What are the symptoms and signs of a hematoma?

Symptoms of a hematoma generally depend on its size and location. Pain, swelling, redness, and
disfiguring bruises are common symptoms of hematoma in general. Some symptoms specific to
the location of a hematoma are:

Subdural hematoma: headache, neurologic problems (weakness on one side, difficulty

speaking, falling), confusion, seizures
Epidural hematoma: back pain, weakness, loss of bowel or bladder control
Subungual hematoma: nail pain, nail weakness, nail loss, disfiguring nail
Splenic, hepatic, or peritoneal hematoma: abdominal pain, flank pain

Sometimes there are not any symptoms at all associated with even a very large hematoma. For
example, if bleeding happens to be inside the abdominal cavity, it can expand into a very large
size before it causes any symptoms. This can happen because the hematoma can spread in a
relatively free space without pressing on any organs to cause pain or other symptoms.
On the other hand, a small hematoma under the nail can present with a lot of pain because the
blood expands into a very tight space under the nail bed and causes inflammation and irritation
of the nearby nail and skin, resulting in pain and swelling.

When should I seek medical care for a hematoma?

Medical attention may be sought for a hematoma if its symptoms are severe or its size continues
to expand. For example, hematoma in the brain (subdural) or epidural hematoma generally
require prompt medical and surgical attention, especially if they are associated with neurologic
problems.
Doctors who typically care for patients with hematoma are emergency room physicians, urgent
care physicians, surgeons, neurosurgeons, and internal medicine doctors.

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 of a hematoma. 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 a hematoma in the abdominal cavity (intraabdominal, hepatic, splenic, retroperitoneal, 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 the clinical situation. Some may
require no treatment at all while others may be deemed a medical emergency.

Can I care for a hematoma 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
Compress
Elevate

What is the medical treatment for a hematoma?

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 from a hematoma can
be treated with pain mediations such as acetaminophen (Tylenol).
Surgical drainage is a common method of treatment for certain hematomas. Presence of
symptoms and location of the hematoma 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.

Should I follow-up with my doctor?

Location, symptoms, and size of a hematoma are the typical factors that determine its proper
follow-up. For example a small, symptom-free (asymptomatic) subdural hematoma may only
require repeat CT scans of the head every few months for follow-up. On the other hand, a large
leg hematoma that had been opened and drained may be observed within a few days to ensure
expected improvement.

Can a hematoma be prevented?

Prevention of all hematomas is not entirely possible. However, prevention of hematomas 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.

What is the outlook after suffering from a hematoma?

In general, the outlook for hematoma is favorable, and most times they do not lead to serious
illness or disability. The location of a hematoma may play a role in its prognosis.