Dr. Nabi Darya Vali (AIIMS)MBBS

June 22, 2020

June 04, 2022


Ever noticed a dark blue or black spot forming on your arm or legs after a fall? While most people dismiss the common injury, sometimes the spot could be more than a small bruise: a bruise occurs because of damage to a small blood vessel(s), but when a larger blood vessel gets damaged, it could lead to a hematoma.

A hematoma is the collection of blood outside a large blood vessel. Hematomas usually occur after the wall of a blood vessel (artery, vein, or capillary) gets damaged and the blood leaks into the surrounding tissue. Unlike a haemorrhage in which the bleeding does not stop, however, the blood gets clotted in a hematoma.

A hematoma can be small (just a dot of blood) or it can be large and can cause significant damage. Our body can take care of damage caused by minor injuries: whenever there is damage to the vessel wall, the body starts repairing it by activating the blood clotting agents and starts forming fibrin patches. But when the damage is extensive, the body is unable to repair it and the defect keeps on bleeding. This allows some hematomas to expand with time.

The blood that leaks from the damaged blood vessels causes inflammation, pain, swelling, and redness in the surrounding tissue. Hematomas may occur anywhere in the body but their symptoms depend upon their location, size and the underlying reason for the hematoma.

While most hematomas resolve on their own, some—especially those hematomas that are not visible to the naked eye—may require urgent medical attention. Hematomas can be dangerous for those who are on blood thinners (anticoagulants) or have any blood clotting disease.

Types of hematoma

Hematomas have been classified based on where they appear in the body. The different types of hematoma are:

  • Subcutaneous hematoma: Hematoma that appears just under the surface of the skin.
  • Aural hematoma: This is another name for ear hematoma. It is usually seen between the cartilage of the ear and the skin over it. It can commonly be seen in wrestlers or boxers.
  • Scalp hematoma: A blood-filled bump on the head is called a scalp hematoma. It does not affect the brain as the damage is on the external skin and muscle.
  • Septal hematoma: Septal hematoma refers to the accumulation of blood after a broken nose.
  • Subungual hematoma: In subungual hematoma, there is a blood clot under the nail. It can be seen in minor injuries to the nail.
  • Retroperitoneal hematoma: Any hematoma inside the abdominal cavity, but not within any organs, is called a retroperitoneal hematoma. It may not be visible to the naked eye.
  • Splenic hematoma: A hematoma that appears inside the spleen, a splenic hematoma may sometimes be seen by the naked eye.
  • Hepatic hematoma: A hematoma inside the liver, a hepatic hematoma is not visible to the naked eye.
  • Intracranial epidural hematoma: This refers to a hematoma that occurs between the bone of the skull and the outer lining of the brain. It would not be visible to the naked eye.
  • Subdural hematoma: Subdural hematoma is the collection of blood between the brain tissue and the inner layer of the brain. It would not be visible from the outside.
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Hematoma symptoms

Superficial hematomas—the ones that can be seen with the naked eyes—may present with the following symptoms:

  • Discolouration of skin, which may change from red to blue to green to yellow as the days go by
  • Inflammation in the area
  • Swelling and tenderness in the area
  • Redness
  • Warm skin around the hematoma
  • Pain in the affected area

Internal hematomas are difficult to recognise without getting proper scans. Anyone who has sustained a serious injury must get themselves checked by a doctor at regular intervals.

Hematomas in the skull are dangerous, as they might not present with symptoms immediately.

According to a study published in the Asian Journal of Neurosurgery in 2014, the symptoms of subdural hematomas usually show up within 72 hours of sustaining the injury. A person with a hematoma in the head may present with the following symptoms:

  • Severe headache which worsens with time
  • Unequal size of the pupils or the pupils do not change when exposed to darkness or light
  • Difficulty breathing
  • Loss of control over bodily functions 
  • Unable to move an arm or leg
  • Loss of hearing
  • Difficulty in swallowing or speaking
  • Sleepiness and drowsiness
  • Vomiting and nausea
  • Irritated and angry behaviour
  • Deformed head or face
  • Clear or bloody fluid coming out from the mouth, nose or ears
  • Sudden loss of consciousness (fainting)
  • State of confusion or difficulty in remembering 
  • Seizures or convulsions 
  • Paralysis

There are certain symptoms which may require immediate medical care, as they could be signs of a life-threatening condition. These symptoms are:

  • State of confusion
  • Fatigue or lethargy soon after a head trauma
  • Multiple episodes of vomiting after a head trauma
  • Injury in the neck or back
  • Expanding hematoma in a person with pre-existing blood clotting (coagulation) disorder or in a person who is on blood thinners (anticoagulant medications). 
  • Deep wound with severe bleeding from the head or face
  • Shallow breathing or difficulty in breathing
  • Unconsciousness after trauma
  • Seizures after a trauma
  • Clear or blood-tinged fluid coming out from nose or ears

Causes of hematoma

The most common cause of a hematoma is an injury or trauma that damages the blood vessel walls. Any damage to the blood vessel walls disrupts their integrity, resulting in a hematoma. Minor traumas lead to smaller hematomas. For instance, a small stroke to the nail could lead to the formation of a small subungual (under nail) hematoma. However, severe traumas can cause major hematomas. For instance, getting into a motor vehicle accident can cause large visible hematomas or invisible hematomas to the head, chest or abdomen.

Hematomas are most commonly seen in the following conditions:

  • Invasive medical and dental procedures involving biopsy, incision and drainage (done to drain pus) and cardiac catheterization can lead to the formation of a hematoma
  • Injections used for delivering medications like insulin, blood thinners and vaccines can damage nearby tissues and blood vessels, often leading to hematomas. 
  • Blood thinner medications such as warfarin, aspirin, clopidogrel and Persantine impair the body's ability to make blood clots. That's why people on these drugs are more likely to get a hematoma than others.
  • Nonsteroidal anti-inflammatory drugs or NSAIDs such as ibuprofen can also cause a hematoma.
  • Supplements such as vitamin E, garlic supplements and Ginkgo biloba can increase the risk of hematoma formation in the body.
  • Hematoma is commonly seen in medical conditions such as long-standing liver disease, bleeding disorders such as haemophilia, Von Willebrand disease and thrombocytopenia (low platelet count).
  • Hematoma can be seen in people suffering from blood cancer.

Sometimes, a hematoma may occur spontaneously without any identifiable cause.

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Hematoma prevention

You cannot entirely prevent hematomas. If you or a loved one is taking blood thinners or anti-platelet medication, be alert as they are more prone to get hematomas if they fall. If they fall, they can get hematomas in their legs, chest, or even brain which can be life-threatening.

Hematomas are also common in children, as they fall frequently while playing. In order to prevent such falls, an adult should supervise the kids while they play.  

Infants are more prone to bumping their head in the house causing a small egg-shaped swelling in the area. In order to avoid this, you can child-proof your home and furniture, which involves covering all sharp corners of your house.

How is a hematoma diagnosed?

A doctor can easily examine a hematoma if it is clearly visible to the naked eye. There are no specific blood tests for diagnose a hematoma. However, if the hematoma is not visible to the naked eye, other diagnostic measures would be required to find out its location and progression. 

Some tests such as complete blood count (CBC), clotting factors and liver examination would be required to assess any underlying conditions which could be responsible for the hematoma formation. Imaging studies that may be required to diagnose hematoma inside the body are as follows:

  • CT scan or MRI scan (magnetic resonance imaging) of the head to diagnose subdural hematoma.
  • CT scan of the abdomen to diagnose intra-abdominal, hepatic, splenic, retroperitoneal and/or peritoneal hematomas.

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Difference between a bruise and a hematoma

A bruise and a hematoma may appear to be similar because of their colour and tenderness, but they are completely different. 

A bruise occurs whenever there is a leakage of blood from small blood vessels leading to the formation of a purple or dark blue coloured spot on the skin. As bruises heal, their colour changes to light yellowish and then completely fades out. They are not serious and do not require medical care. People with anaemia or vitamin deficiency are prone to get bruises more often.

On the other hand, a hematoma occurs when there is a leakage from a larger blood vessel. The colour of a hematoma is darker (blue or black) along with significant redness. Severe traumas may lead to serious internal hematomas which would require medical treatment.

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Hematoma treatment

Minor hematomas can be managed at home. However, if a person has a pre-existing medical condition like a clotting disorder or has survived a major trauma, then you must seek medical help.

  1. Treatment of minor hematoma at home
  2. Drug therapy for hematoma
  3. Surgical treatment for a hematoma

Treatment of minor hematoma at home

In some cases, the hematoma resolves on its own, without any treatment. If the hematoma is visible, minor and superficial (just under the skin), then simple therapies at home can help. One such therapy is commonly known as RICE, which involves:

  • Resting
  • Icing the area with an ice or gel pack for 20 minutes at a time, four to eight times a day to reduce any pain or swelling
  • Compression of the area using elastic bandages would help to keep the blood vessel from reopening as it heals
  • Elevating the area above the level of the heart

Drug therapy for hematoma

Some over-the-counter medications can be used to relieve pain. However, people are advised to avoid pain-killer medications containing aspirin, as it would worsen the hematoma.

Surgical treatment for a hematoma

In some cases, the blood may have to be drained from the hematoma. Doctors typically consider this surgical intervention only when the hematoma is putting pressure on the spinal cord, brain, or other vital organs, to reduce the risk of organ damage.

However, surgical treatment may not be necessary in all the major cases, including brain hematoma. According to a study published in the Journal of Neurosurgery in 2015, only 6.5% of patients with a subdural hematoma require surgical treatment at a later stage.

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